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General NPI Number Information
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NPI Number | 1174509145
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Entity Type | Individual
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Provider Name | WILLERT HOWARD LYNN III MD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 800 TOWNE PARK DR SUITE 400
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City | RINCON
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State | GA
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Zip | 31326-5156
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Country | US
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Telephone | 912-826-1220
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Fax | 912-826-1216
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Provider Business Mailing Address
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Address Line | PO BOX 2055
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City | RINCON
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State | GA
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Zip | 31326-2055
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Country | US
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Telephone | 912-826-1220
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Fax | 912-826-1216
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | GA 47979
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License Number State | GA
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