Healthcare Provider Details

I. General information

NPI: 1629050174
Provider Name (Legal Business Name): BILLY PAUL LYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SAINT SEBASTIAN WAY STE 1A
AUGUSTA GA
30901-2635
US

IV. Provider business mailing address

3696 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-8400
  • Fax: 706-651-8868
Mailing address:
  • Phone: 706-736-1830
  • Fax: 706-650-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number13549
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number024290
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: