Lake, Marlyn A

Lake, Marlyn A is an individual health care provider with primary practice located at 380 Hospital Dr Ste 370 , Macon GA 31217-8010. She recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as her primary health care specialty. Lake, Marlyn A can be contacted via phone (478) 219-7735.

Contact Information

Primary practice address
380 Hospital Dr Ste 370 Macon GA 31217-8010
Phone: (478) 219-7735
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X ME76490 Florida
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 84646 Georgia

Profile Details

NPI number 1952405318
LBN Legal business name Lake, Marlyn A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2006
Last updated Apr 14th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952405318 NPPES
Florida Other NT772 FL HF MEDICARE
Florida MEDICAID 257303200 FL HF MEDICARE
Florida Other 44751 FL HF MEDICARE

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