Healthcare Provider Details

I. General information

NPI: 1235283219
Provider Name (Legal Business Name): PATRICIA ANNE FLYNN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICIA ANNE MCCARTY

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MARBLE MILL RD NW
MARIETTA GA
30060-1047
US

IV. Provider business mailing address

111 MARBLE MILL RD NW
MARIETTA GA
30060-1047
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1013
  • Fax: 770-514-5999
Mailing address:
  • Phone: 770-422-1013
  • Fax: 770-514-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 9100967
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5936
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: