Provider Demographics
NPI:1932145208
Name:LYNN, KATHY CLARICE (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:CLARICE
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:446 POPLAR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3336
Mailing Address - Country:US
Mailing Address - Phone:478-742-0483
Mailing Address - Fax:478-216-5405
Practice Address - Street 1:446 POPLAR ST STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3336
Practice Address - Country:US
Practice Address - Phone:478-742-0483
Practice Address - Fax:478-216-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034889207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF08377Medicare UPIN