Healthcare Provider Details

I. General information

NPI: 1518352525
Provider Name (Legal Business Name): TAMMY CERELIA FLUCAS CRT,RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 MARGAUX DR
ATLANTA GA
30349-2056
US

IV. Provider business mailing address

3871 MARGAUX DR
ATLANTA GA
30349-2056
US

V. Phone/Fax

Practice location:
  • Phone: 919-559-9350
  • Fax:
Mailing address:
  • Phone: 919-559-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number8068
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: