=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942618335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNN BECKMANN NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2014
-----------------------------------------------------
Last Update Date | 07/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 RESEARCH DR
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30605-2738
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-583-2868
-----------------------------------------------------
Fax | 706-369-5640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 289 HANOVER DR
-----------------------------------------------------
City | BOGART
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30622-1734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-296-7740
-----------------------------------------------------
Fax | 706-369-5640
-----------------------------------------------------
=====================================================
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 | RN109792
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------