Healthcare Provider Details

I. General information

NPI: 1689895336
Provider Name (Legal Business Name): GEYSA FLORES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ATLANTA HWY SUITE 303
CUMMING GA
30040-8099
US

IV. Provider business mailing address

2450 ATLANTA HWY STE 1903
CUMMING GA
30040-1237
US

V. Phone/Fax

Practice location:
  • Phone: 678-845-8596
  • Fax: 678-802-6985
Mailing address:
  • Phone: 678-845-8596
  • Fax: 678-802-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8262
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: