Provider Demographics
NPI:1285617324
Name:DUNAWAY, LYNN P (PAAA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:DUNAWAY
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:DUNAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAAA
Mailing Address - Street 1:671 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4356
Mailing Address - Country:US
Mailing Address - Phone:770-227-6141
Mailing Address - Fax:
Practice Address - Street 1:11 UPPER RIVERDALE RD.
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-1254
Practice Address - Country:US
Practice Address - Phone:770-478-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR069772367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000338AAMedicaid
GA43ZCBKP13Medicare ID - Type UnspecifiedANESTHSIA
GA100000338AAMedicaid