Provider Demographics
NPI:1952722753
Name:BIBB, AUDREY LYNN (MS,)
Entity Type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:LYNN
Last Name:BIBB
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:ROSEANN
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,
Mailing Address - Street 1:2165 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5307
Mailing Address - Country:US
Mailing Address - Phone:404-778-8597
Mailing Address - Fax:404-778-8562
Practice Address - Street 1:2165 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5307
Practice Address - Country:US
Practice Address - Phone:404-778-8597
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS