Healthcare Provider Details

I. General information

NPI: 1962578898
Provider Name (Legal Business Name): ERNIE E LIN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 PLEASANT HOME RD. SUITE F-3
AUGUSTA GA
30907-0559
US

IV. Provider business mailing address

211 PLEASANT HOME RD STE F3
AUGUSTA GA
30907-0559
US

V. Phone/Fax

Practice location:
  • Phone: 706-855-5666
  • Fax: 706-855-7248
Mailing address:
  • Phone: 706-855-5666
  • Fax: 706-855-7248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number40460
License Number StateGA

VIII. Authorized Official

Name: DR. ERNIE E LIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 706-855-5666