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General NPI Number Information
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NPI Number | 1114241064
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Entity Type | Individual
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Provider Name | ERNEST L. FLETCHER MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 80 VININGS DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-5994
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Country | US
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Telephone | 678-284-6291
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Fax |
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY STE 584
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 678-314-8935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23994
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 64538
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License Number State | GA
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