Active NPI
Lynette S Jattan-Cunningham, M.D.
- Pediatrics Physician
- Covington, GA
National Provider Identifier
1003964594
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 040421
- Practice address
- 7138 Highway 212 Ste C
Covington, GA 30016-8047 - Phone
- (770) 788-1554
- NPI assigned
- Jan 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 040421 | GA | Primary |
Addresses
Primary practice location
7138 Highway 212 Ste C
Covington, GA 30016-8047
Mailing address
1277B Wellbrook Cir NE
Conyers, GA 30012-3873
Phone (770) 922-5745
Other practice location 1
1277 Wellbrook Cir NE Ste B
Conyers, GA 30012-3973
Phone (770) 922-5745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000673373A | Medicaid | GA |
Other names 1
- Lynette S. Jattan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040421 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conyers Pediatrics, PC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Conyers, GA
- NPI 1831217157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635379200000",
"number": "1003964594",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1277B WELLBROOK CIR NE",
"city": "CONYERS",
"state": "GA",
"postal_code": "300123873",
"telephone_number": "770-922-5745",
"fax_number": "770-922-4924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7138 HIGHWAY 212 STE C",
"city": "COVINGTON",
"state": "GA",
"postal_code": "300168047",
"telephone_number": "770-788-1554"
}
],
"practiceLocations": [
{
"address_1": "1277 Wellbrook Cir NE Ste B",
"address_purpose": "LOCATION",
"city": "Conyers",
"state": "GA",
"postal_code": "300123973",
"country_code": "US",
"telephone_number": "770-922-5745",
"fax_number": "770-922-4924",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JATTAN-CUNNINGHAM",
"first_name": "LYNETTE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-08",
"last_updated": "2021-10-28",
"certification_date": "2021-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "040421",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000673373A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LYNETTE",
"last_name": "JATTAN",
"middle_name": "S.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Covington, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.