=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073511283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNNE S ROLLINS RNC, APRN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 BROAD ST
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-3017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-295-6701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6345 REINHARDT COLLEGE PKWY
-----------------------------------------------------
City | WALESKA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30183-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-479-4613
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN037833
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------