Provider Demographics
NPI:1104880558
Name:PINSON, LORNA GAYE (MD)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:GAYE
Last Name:PINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LORNA
Other - Middle Name:GAYE
Other - Last Name:MCCOLLUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:744 W MICHIGAN AVE STE 301A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1900
Mailing Address - Country:US
Mailing Address - Phone:517-782-2540
Mailing Address - Fax:517-782-1560
Practice Address - Street 1:3235 EAST MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-782-2540
Practice Address - Fax:517-782-1560
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI053445208D00000X
MI4301-053445208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3388592Medicaid
F35613Medicare UPIN
MION32720Medicare ID - Type Unspecified