MEDICARE: DR. LYNDA DIRK MS, DVM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	VET009547	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VET009547	OTHER	GA	GEORGIA STATE BOARD OF VETERINARY MEDICINE

General Provider Information

NPI Number	:	1093164162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNDA DIRK MS, DVM

Provider Business Mailing Address
First Line	:	455 ABERNATHY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-2505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 ABERNATHY RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-2505
Country	:	US
Telephone Number	:	404-459-0903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	06/08/2016

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