Healthcare Provider Details

I. General information

NPI: 1619559168
Provider Name (Legal Business Name): ADAM COLIN FLYNN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 DAWSON RD
ALBANY GA
31707-1609
US

IV. Provider business mailing address

132 ALACHUA LN
ALBANY GA
31707-1235
US

V. Phone/Fax

Practice location:
  • Phone: 229-496-2472
  • Fax:
Mailing address:
  • Phone: 229-938-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN248789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: