1356447650 NPI number — LINDA LAMM GERARD M.D

Table of content: LINDA LAMM GERARD M.D (NPI 1356447650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356447650 NPI number — LINDA LAMM GERARD M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERARD
Provider First Name:
LINDA
Provider Middle Name:
LAMM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1356447650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1117
Provider Second Line Business Mailing Address:
10025 FORD AVE., SUITE 3-A
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31324-1117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-756-3404
Provider Business Mailing Address Fax Number:
912-756-2156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10025 FORD AVE
Provider Second Line Business Practice Location Address:
SUITE 3-A
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31324-8804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-756-3404
Provider Business Practice Location Address Fax Number:
912-756-2156
Provider Enumeration Date:
09/15/2006

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: 207V00000X , with the licence number:  028168 , 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: 000313255B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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