Provider Demographics
NPI:1720083900
Name:LYNN, ANDREW W (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:LYNN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 EMORY VALLEY RD
Mailing Address - Street 2:STE C
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7764
Mailing Address - Country:US
Mailing Address - Phone:865-481-3338
Mailing Address - Fax:865-481-0477
Practice Address - Street 1:659 EMORY VALLEY RD
Practice Address - Street 2:STE C
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7764
Practice Address - Country:US
Practice Address - Phone:865-481-3338
Practice Address - Fax:865-481-0477
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000332213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3011580OtherBLUECROSS BLUESHIELD
TN3351444Medicaid
TN4065733OtherAETNA
TN2740012OtherUNITED HEALTHCARE
TN2366703OtherCIGNA
TNT61115Medicare UPIN
TN3351444Medicaid
TN2366703OtherCIGNA