1417356437 NPI number — CHRISTINA P LYNN, MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417356437 NPI number — CHRISTINA P LYNN, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINA P LYNN, MD
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:
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:
1417356437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1229 38TH AVE N # 411
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29577-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-6122
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1418 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT CARMEL
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-839-6122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
PITTS
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
843-839-6122

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  35441 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 68906 . This is a "MD PSYCHOLOGY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 036.151498 . This is a "PHYS & SURGEON" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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