Healthcare Provider Details

I. General information

NPI: 1124555354
Provider Name (Legal Business Name): LORRAINE LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MILLEDGEVILLE HWY
GORDON GA
31031-3827
US

IV. Provider business mailing address

PO BOX 371
WRIGHTSVILLE GA
31096-0371
US

V. Phone/Fax

Practice location:
  • Phone: 478-946-1030
  • Fax: 478-864-1288
Mailing address:
  • Phone: 478-864-3448
  • Fax: 478-864-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN256492
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: