MEDICARE: JARA LYNN SOUTHERLAND NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	71008724A	IN

General Provider Information

NPI Number	:	1881167997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARA LYNN SOUTHERLAND NP

Provider Business Mailing Address
First Line	:	PO BOX 746720
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6720
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	773-866-8014

Provider Business Practice Location Address
First Line	:	711 E 38TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-2748
Country	:	US
Telephone Number	:	463-249-2314
Fax Number	:	317-245-2388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	06/17/2026

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