Provider Demographics
NPI:1548728579
Name:LYNCH, TARA S (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PMHNP-BC
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3436 HADDON HALL CT
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7305
Mailing Address - Country:US
Mailing Address - Phone:479-936-6629
Mailing Address - Fax:
Practice Address - Street 1:3305 BRECKINRIDGE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4932
Practice Address - Country:US
Practice Address - Phone:770-495-9775
Practice Address - Fax:770-495-9745
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN239727363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty