=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235921412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PCOS SISTERS TELEHEALTH CLINIC & WELLNESS CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 W PEACHTREE ST NW STE 2300
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-3453
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-586-1964
-----------------------------------------------------
Fax | 888-597-2357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 528 SCOTT BLVD
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30030-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-531-1019
-----------------------------------------------------
Fax | 888-597-2357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO, MEMBER
-----------------------------------------------------
Name | LYNSEY AMANDA JOHNSON
-----------------------------------------------------
Credential | FNP, DNP
-----------------------------------------------------
Telephone | 912-531-1019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------