Provider Demographics
NPI:1265799589
Name:LYNES, NATHAN SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:SAMUEL
Last Name:LYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5150 STILESBORO RD NW STE 220
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7742
Mailing Address - Country:US
Mailing Address - Phone:770-424-8222
Mailing Address - Fax:770-424-9962
Practice Address - Street 1:5150 STILESBORO RD NW STE 220
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7742
Practice Address - Country:US
Practice Address - Phone:770-424-8222
Practice Address - Fax:770-424-9962
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics