Provider Demographics
NPI:1962578898
Name:ERNIE E LIN, MD, PC
Entity type:Organization
Organization Name:ERNIE E LIN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-855-5666
Mailing Address - Street 1:211 PLEASANT HOME RD STE F3
Mailing Address - Street 2:
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 RD.
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40460261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52598825OtherBC-BS PROVIDER NUMBER
GAP00063679OtherMEDICARE RAILROAD
GAP00063679OtherMEDICARE RAILROAD
GA25BDBQJMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
GAG98399Medicare UPIN
GA25BDBQJMedicare PIN