Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 040421 | GA |
NPI | 1003964594 |
---|---|
Provider Name | Dr. Lynette S Jattan-Cunningham |
First Address | Conyers, GA 30012-3873 |
Second Address | Covington, GA 30016-8047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000673373A | (05) | GA |