Provider Demographics
NPI:1366472144
Name:LYN-BOSWELL, CARLA (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:LYN-BOSWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:LYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3030 COVINGTON PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5049
Mailing Address - Country:US
Mailing Address - Phone:901-383-8889
Mailing Address - Fax:901-384-6309
Practice Address - Street 1:4066 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-5225
Practice Address - Country:US
Practice Address - Phone:901-452-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine