Healthcare Provider Details

I. General information

NPI: 1194792010
Provider Name (Legal Business Name): ANNETTE WILLIAMS LYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 SAINT JULIAN PL
COLUMBIA SC
29204-2410
US

IV. Provider business mailing address

1706 SAINT JULIAN PL
COLUMBIA SC
29204-2410
US

V. Phone/Fax

Practice location:
  • Phone: 803-771-7506
  • Fax: 803-771-9455
Mailing address:
  • Phone: 803-771-7506
  • Fax: 803-771-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number15799
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: