Provider Demographics
NPI:1457365736
Name:CLEAVELAND, LYNWOOD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNWOOD
Middle Name:PAUL
Last Name:CLEAVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 TATE ST NE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2551
Mailing Address - Country:US
Mailing Address - Phone:770-787-7970
Mailing Address - Fax:770-483-3291
Practice Address - Street 1:4122 TATE ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2551
Practice Address - Country:US
Practice Address - Phone:770-787-7970
Practice Address - Fax:770-483-3291
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023925208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAFO1679Medicare UPIN
GA34BDBBGMedicare ID - Type Unspecified