Provider Demographics
NPI:1417359860
Name:BARNES, LYNN (ATC, LAT)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 OLD LIFSEY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MOLENA
Mailing Address - State:GA
Mailing Address - Zip Code:30258-2448
Mailing Address - Country:US
Mailing Address - Phone:770-584-5186
Mailing Address - Fax:
Practice Address - Street 1:612 W GORDON ST
Practice Address - Street 2:SUITE E
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-647-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0017712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer