Healthcare Provider Details

I. General information

NPI: 1497712061
Provider Name (Legal Business Name): FREDRIC B FLAX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 C OLD MILTON PKWY STE 545
ALPHARETTA GA
30005
US

IV. Provider business mailing address

3400 C OLD MILTON PKWY STE 545
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-0800
  • Fax: 770-751-7198
Mailing address:
  • Phone: 770-751-0800
  • Fax: 770-751-7198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: