=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568604627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLAGLER MEDICAL CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2009
-----------------------------------------------------
Last Update Date | 04/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 HOWELL MILL RD NW SUITE C-346
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-237-6448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 HOWELL MILL RD NW SUITE C-346
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-237-6448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. REYNIER SANTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-237-6448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------