Healthcare Provider Details

I. General information

NPI: 1124414628
Provider Name (Legal Business Name): BETH ANNE FLACK DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4246 WASHINGTON RD STE 6
EVANS GA
30809-3345
US

IV. Provider business mailing address

4246 WASHINGTON RD STE 6
EVANS GA
30809-3345
US

V. Phone/Fax

Practice location:
  • Phone: 706-305-3241
  • Fax: 706-733-6018
Mailing address:
  • Phone: 706-305-3241
  • Fax: 706-229-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCHIR009305
License Number StateGA

VIII. Authorized Official

Name: DR. BETH ANNE FLACK
Title or Position: OWNER
Credential: D.C.
Phone: 706-305-3241