MEDICARE: DR. PHILIP JOHN FLORES PHD

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	103T00000X	Psychologist	000897	GA

General Provider Information

NPI Number	:	1811083652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP JOHN FLORES PHD

Provider Business Mailing Address
First Line	:	6065 LAKE FORREST DR
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	404-250-9340
Fax Number	:	770-579-1967

Provider Business Practice Location Address
First Line	:	6065 LAKE FORREST DR
Second Line	:	SUITE 150
City	:	ATLANTA
State	:	GA
Zip	:	30328
Country	:	US
Telephone Number	:	404-250-9340
Fax Number	:	770-579-1967

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. PHILIP JOHN FLORES PHD” Practice Location

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