Healthcare Provider Details

I. General information

NPI: 1306858162
Provider Name (Legal Business Name): THEIN LWIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121A BELLEVUE RD CSB OF MIDDLE GEORGIA
DUBLIN GA
31021-2998
US

IV. Provider business mailing address

2121A BELLEVUE RD CSB OF MIDDLE GEORGIA
DUBLIN GA
31021-2998
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1190
  • Fax: 478-274-7628
Mailing address:
  • Phone: 478-272-1190
  • Fax: 478-274-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number042646
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: