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General NPI Number Information
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NPI Number | 1457128613
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Entity Type | Organization
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Legal Business Name | FLEX SPORTS MEDICINE AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/07/2023
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 4490 WASHINGTON RD STE 2
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City | EVANS
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State | GA
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Zip | 30809-5899
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Country | US
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Telephone | 762-930-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 4490 WASHINGTON RD STE 2
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City | EVANS
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State | GA
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Zip | 30809-5899
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Country | US
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Telephone | 762-930-3539
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BEAU P GEDRICK
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Credential | DO
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Telephone | 762-930-3539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number |
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License Number State |
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