MEDICARE: DR. ANDREA LAVERNE FLEMING PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY001468	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568521342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA LAVERNE FLEMING PH.D.

Provider Business Mailing Address
First Line	:	1320 WYNNTON RD STE D
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2867
Country	:	US
Telephone Number	:	706-660-9335
Fax Number	:	706-660-9210

Provider Business Practice Location Address
First Line	:	1320 WYNNTON RD STE D
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2867
Country	:	US
Telephone Number	:	706-660-9335
Fax Number	:	706-660-9210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	04/06/2018

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