1124243951 NPI number — DR. CHRISTINA MOLDOVANYI LYNN MD

Table of content: DR. CHRISTINA MOLDOVANYI LYNN MD (NPI 1124243951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124243951 NPI number — DR. CHRISTINA MOLDOVANYI LYNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNN
Provider First Name:
CHRISTINA
Provider Middle Name:
MOLDOVANYI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLDOVANYI
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124243951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102321
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-367-3014
Provider Business Mailing Address Fax Number:
404-367-3558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 COLLIER RD NW
Provider Second Line Business Practice Location Address:
SUITE 635
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-367-3014
Provider Business Practice Location Address Fax Number:
404-367-3558
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  059462 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 059462 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00434359 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 256597995A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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