Provider Demographics
NPI:1063606952
Name:DR LYNN CARTER INC
Entity type:Organization
Organization Name:DR LYNN CARTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-534-6555
Mailing Address - Street 1:419 BRADFORD ST NW
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3285
Mailing Address - Country:US
Mailing Address - Phone:770-534-6555
Mailing Address - Fax:770-532-2906
Practice Address - Street 1:419 BRADFORD ST NW
Practice Address - Street 2:SUITE A-1
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3285
Practice Address - Country:US
Practice Address - Phone:770-534-6555
Practice Address - Fax:770-532-2906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700129Medicare PIN