Healthcare Provider Details

I. General information

NPI: 1073854469
Provider Name (Legal Business Name): A LYNN DOLSON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 MAHAN CENTER BLVD SUITE 103
TALLAHASSEE FL
32308-5474
US

IV. Provider business mailing address

1614 MAHAN CENTER BLVD SUITE 103
TALLAHASSEE FL
32308-5474
US

V. Phone/Fax

Practice location:
  • Phone: 850-591-9703
  • Fax:
Mailing address:
  • Phone: 850-591-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME58576
License Number StateFL

VIII. Authorized Official

Name: DR. LYNN DOLSON
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 850-591-9703