Basic Information
Provider Information
NPI: 1427116656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STAMEGNA
FirstName: LYNN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: APRN,BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2540 WINDY HILL RD SE
Address2:  
City: MARIETTA
State: GA
PostalCode: 300678605
CountryCode: US
TelephoneNumber: 7706441570
FaxNumber: 7706441576
Practice Location
Address1: 1000 JOHNSON FERRY RD
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421606
CountryCode: US
TelephoneNumber: 4048518000
FaxNumber: 4043033759
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 03/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364S00000XRN127250GAY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist 

No ID Information.


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