Healthcare Provider Details

I. General information

NPI: 1851449524
Provider Name (Legal Business Name): PERRY F FLYNN M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FERGUSON BLD UNIVERSITY OF NORTH CAROLINA GREENSBORO
GREENSBORO NC
27402-6170
US

IV. Provider business mailing address

300 FERGUSON BLD UNIVERSITY OF NORTH CAROLINA GREENSBORO
GREENSBORO NC
27402-6170
US

V. Phone/Fax

Practice location:
  • Phone: 336-256-2005
  • Fax: 336-334-4475
Mailing address:
  • Phone: 336-256-2005
  • Fax: 336-334-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2233
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: