Healthcare Provider Details

I. General information

NPI: 1962693879
Provider Name (Legal Business Name): LYNN MCNAIR ROUNTREE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 PARKER DAIRY RD
DUBLIN GA
31021-0211
US

IV. Provider business mailing address

651 PARKER DAIRY RD
DUBLIN GA
31021-0211
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-3186
  • Fax:
Mailing address:
  • Phone: 478-275-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN182868
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: