Provider Demographics
NPI:1720287345
Name:LOGAN, LYNDA JEAN (RN)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:JEAN
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5398 THOMASTON ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220
Mailing Address - Country:US
Mailing Address - Phone:478-476-8868
Mailing Address - Fax:478-476-8161
Practice Address - Street 1:5398 THOMASTON ROAD SUITE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220
Practice Address - Country:US
Practice Address - Phone:478-476-8868
Practice Address - Fax:478-476-8161
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse