Healthcare Provider Details

I. General information

NPI: 1689944209
Provider Name (Legal Business Name): SHARI FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 CASCADE RD SW
ATLANTA GA
30331-2111
US

IV. Provider business mailing address

2638 SUMMIT PKWY SW
ATLANTA GA
30331-9425
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-1909
  • Fax:
Mailing address:
  • Phone: 404-396-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: