Provider Demographics
NPI:1194994244
Name:LIN, ERNIE E (MD)
Entity type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:E
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PLEASANT HOME ROAD
Mailing Address - Street 2:SUITE F-3
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0559
Mailing Address - Country:US
Mailing Address - Phone:706-855-5666
Mailing Address - Fax:706-855-7248
Practice Address - Street 1:211 PLEASANT HOME ROAD
Practice Address - Street 2:SUITE F-3
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-0559
Practice Address - Country:US
Practice Address - Phone:706-855-5666
Practice Address - Fax:706-855-7248
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040460261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA25BDBQJOtherMEDICARE PROVIDER NUMBER
GAP00063679OtherMEDICARE RAILROAD
GA52598825OtherBCBS PROVIDER NUMBER
GA52598825OtherBCBS PROVIDER NUMBER
GAP00063679OtherMEDICARE RAILROAD