Provider Demographics
NPI:1225904634
Name:BOATRIGHT, LINTON DUNBAR
Entity type:Individual
Prefix:MR
First Name:LINTON
Middle Name:DUNBAR
Last Name:BOATRIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-2819
Mailing Address - Country:US
Mailing Address - Phone:912-288-6240
Mailing Address - Fax:
Practice Address - Street 1:142 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2819
Practice Address - Country:US
Practice Address - Phone:912-288-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty