Healthcare Provider Details

I. General information

NPI: 1548899172
Provider Name (Legal Business Name): THOMAS FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MEMORIAL DR STE 100
DALTON GA
30720-8662
US

IV. Provider business mailing address

1107 MEMORIAL DR STE 100
DALTON GA
30720-8662
US

V. Phone/Fax

Practice location:
  • Phone: 706-529-3072
  • Fax: 706-529-3077
Mailing address:
  • Phone: 706-529-3072
  • Fax: 706-529-3077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100706
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number100706
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: