Provider Demographics
NPI:1194792010
Name:LYNN, ANNETTE WILLIAMS (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:WILLIAMS
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SAINT JULIAN PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2410
Mailing Address - Country:US
Mailing Address - Phone:803-771-7506
Mailing Address - Fax:803-771-9455
Practice Address - Street 1:1706 SAINT JULIAN PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2410
Practice Address - Country:US
Practice Address - Phone:803-771-7506
Practice Address - Fax:803-771-9455
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15799207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC157994Medicaid
F29033Medicare UPIN
F290332603Medicare ID - Type Unspecified
SCF290332389Medicare PIN
SC157994Medicaid
SCF290337004Medicare PIN
SCF290332603Medicare PIN
SCF290334810Medicare PIN