Healthcare Provider Details

I. General information

NPI: 1558774950
Provider Name (Legal Business Name): KERRIE ANN LIND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERRIE ANN TIDWELL MD

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PHOENIX BLVD STE 128-12
ATLANTA GA
30349-5593
US

IV. Provider business mailing address

201 STERLING WOODS DR
RICHMOND HILL GA
31324-4376
US

V. Phone/Fax

Practice location:
  • Phone: 844-359-8363
  • Fax:
Mailing address:
  • Phone: 770-378-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101257908
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0079851
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number89945
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number89945
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number89945
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: