Healthcare Provider Details

I. General information

NPI: 1669836268
Provider Name (Legal Business Name): ERINN AFFLICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2016
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 BARNES RD
WILLIAMSTOWN KY
41097-3509
US

IV. Provider business mailing address

4834 ROLLING GREEN DR
WESLEY CHAPEL FL
33543-7007
US

V. Phone/Fax

Practice location:
  • Phone: 843-516-5979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number57773
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: