Healthcare Provider Details

I. General information

NPI: 1245481068
Provider Name (Legal Business Name): BRENT A FLICKINGER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 SMOKY MOUNTAIN SPRINGS LN NE STE A
GAINESVILLE GA
30501-2418
US

IV. Provider business mailing address

961 SMOKY MOUNTAIN SPRINGS LN NE STE A
GAINESVILLE GA
30501-2418
US

V. Phone/Fax

Practice location:
  • Phone: 770-531-3711
  • Fax: 770-531-3718
Mailing address:
  • Phone: 770-531-3711
  • Fax: 770-531-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number059065
License Number StateGA

VIII. Authorized Official

Name: DR. BRENT A FLICKINGER
Title or Position: OWNER
Credential: MD
Phone: 770-531-3711