Basic Information
| Provider Information | |||||||||
| NPI: | 1205152311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNCH | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3036 ROSWELL RD | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300624971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705780785 | ||||||||
| FaxNumber: | 4048601461 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 JOHNSTON ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314055502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123521234 | ||||||||
| FaxNumber: | 9123520492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2010 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 068826 | GA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.