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General NPI Number Information
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NPI Number | 1265799589
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Entity Type | Individual
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Provider Name | NATHAN SAMUEL LYNES M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 5150 STILESBORO RD NW STE 220
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City | KENNESAW
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State | GA
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Zip | 30152-7742
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Country | US
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Telephone | 770-424-8222
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Fax | 770-424-9962
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Provider Business Mailing Address
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Address Line | 5150 STILESBORO RD NW STE 220
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City | KENNESAW
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State | GA
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Zip | 30152-7742
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Country | US
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Telephone | 770-424-8222
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Fax | 770-424-9962
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 074920
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License Number State | GA
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