Basic Information
| Provider Information | |||||||||
| NPI: | 1124213715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 POINTE NORTH DR | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301207952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787210705 | ||||||||
| FaxNumber: | 6787215116 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 POINTE NORTH DR | ||||||||
| Address2: | |||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301207952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787210705 | ||||||||
| FaxNumber: | 6787215116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 060401 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 060401 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 884429229E | 05 | GA | MEDICAID | 884429229A | 05 | GA | MEDICAID | 884429229C | 05 | GA | MEDICAID | 884429229B | 05 | GA | MEDICAID | 884429229D | 05 | GA | MEDICAID |