Healthcare Provider Details

I. General information

NPI: 1053928721
Provider Name (Legal Business Name): LYNN XINHUI GUAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-5420
US

IV. Provider business mailing address

1364 CLIFTON RD NE
ATLANTA GA
30322-3349
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-2000
  • Fax:
Mailing address:
  • Phone: 404-686-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: