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NPI Code Detail

MEDICARE: TARA S LYNCH PMHNP-BC

MEDICARE: TARA S LYNCH PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN239727GA

General Provider Information

NPI Number : 1548728579
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA S LYNCH PMHNP-BC
Provider Business Mailing Address
First Line : 3436 HADDON HALL CT
Second Line :
City : BUFORD
State : GA
Zip : 30519-7305
Country : US
Telephone Number : 479-936-6629
Fax Number :
Provider Business Practice Location Address
First Line : 3305 BRECKINRIDGE BLVD STE 116
Second Line :
City : DULUTH
State : GA
Zip : 30096-4932
Country : US
Telephone Number : 770-495-9775
Fax Number : 770-495-9745
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2019
Last Update Date : 10/03/2022

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