Basic Information
Provider Information
NPI: 1548239130
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BROWN
FirstName: LYNN
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: P.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1009 WINDCROSS CT
Address2: STE 101
City: FRANKLIN
State: TN
PostalCode: 370672678
CountryCode: US
TelephoneNumber: 6152245438
FaxNumber: 8888823919
Practice Location
Address1: 3803 N ELM ST
Address2:  
City: GREENSBORO
State: NC
PostalCode: 274552593
CountryCode: US
TelephoneNumber: 3364021596
FaxNumber: 8888823919
Other Information
ProviderEnumerationDate: 03/16/2006
LastUpdateDate: 04/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X101804NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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