Healthcare Provider Details

I. General information

NPI: 1033288048
Provider Name (Legal Business Name): KEVIN D. FLYTHE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 WINDY HILL RD SE SUITE 200
MARIETTA GA
30067-8602
US

IV. Provider business mailing address

2330 WINDY HILL RD SE SUITE 200
MARIETTA GA
30067-8602
US

V. Phone/Fax

Practice location:
  • Phone: 770-988-0988
  • Fax: 770-988-8989
Mailing address:
  • Phone: 770-988-0988
  • Fax: 770-988-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: