1952566234 NPI number — MARK LYNN OD & ASSOCIATES PC

Table of content: JENNIFER LIEBERMAN M.A., LMFT (NPI 1154868339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952566234 NPI number — MARK LYNN OD & ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK LYNN OD & ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952566234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848560
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-8560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-524-6663
Provider Business Mailing Address Fax Number:
210-524-6587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3360 SHELBY LN
Provider Second Line Business Practice Location Address:
STE. 1010
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344-5744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-344-0274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-285-5050

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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