Healthcare Provider Details

I. General information

NPI: 1477578599
Provider Name (Legal Business Name): JONATHAN P LYNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 5TH ST SE
CAIRO GA
39828-3141
US

IV. Provider business mailing address

1178 5TH ST SE
CAIRO GA
39828-3141
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-2002
  • Fax: 229-377-0930
Mailing address:
  • Phone: 229-377-2002
  • Fax: 229-377-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL27868
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number060402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: