1508266388 NPI number — AMY XJ LIN, LLC

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 1508266388 NPI number — AMY XJ LIN, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMY XJ LIN, LLC
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:
1508266388
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4720 PEACHTREE INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
BERKELEY LAKE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30071-5735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4720 PEACHTREE INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
BERKELEY LAKE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30071-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-454-9047
Provider Business Practice Location Address Fax Number:
770-457-6311
Provider Enumeration Date:
08/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
770-569-3988

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  060560 , 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)





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