Healthcare Provider Details

I. General information

NPI: 1174508790
Provider Name (Legal Business Name): JACKLYN P LINDER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

3653 LYNNWOOD DR
MARTINEZ GA
30907-2841
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4760
  • Fax: 706-432-3780
Mailing address:
  • Phone: 706-860-6805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLPC002352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: