Provider Demographics
NPI:1184991051
Name:HALL, LYNN R (RD/LD, CDE)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:RD/LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 OLD HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6248
Mailing Address - Country:US
Mailing Address - Phone:706-632-4224
Mailing Address - Fax:706-258-4674
Practice Address - Street 1:2855 OLD HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6248
Practice Address - Country:US
Practice Address - Phone:706-632-4224
Practice Address - Fax:706-258-4674
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001523133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered