Healthcare Provider Details

I. General information

NPI: 1437511706
Provider Name (Legal Business Name): ERIC LIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W STE 103
FAYETTEVILLE GA
30214-4537
US

IV. Provider business mailing address

110 29TH AVE N STE 201
NASHVILLE TN
37203-1458
US

V. Phone/Fax

Practice location:
  • Phone: 678-216-0771
  • Fax:
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60877
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number88531
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: