Healthcare Provider Details

I. General information

NPI: 1417356437
Provider Name (Legal Business Name): CHRISTINA P LYNN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 COLLEGE DR
MT CARMEL IL
62863
US

IV. Provider business mailing address

1229 38TH AVE N # 411
MYRTLE BEACH SC
29577-1313
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-6122
  • Fax:
Mailing address:
  • Phone: 843-839-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35441
License Number StateSC

VIII. Authorized Official

Name: DR. CHRISTINA PITTS LYNN
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 843-839-6122