Provider Demographics
NPI:1881619989
Name:LYNN, CAROL INGRAM (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:INGRAM
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 W POPLAR AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0618
Mailing Address - Country:US
Mailing Address - Phone:901-755-2900
Mailing Address - Fax:901-755-2975
Practice Address - Street 1:2028 W POPLAR AVE STE 110
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0618
Practice Address - Country:US
Practice Address - Phone:901-755-2900
Practice Address - Fax:901-755-2975
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25604174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802994Medicare ID - Type Unspecified
TNG31012Medicare UPIN