MEDICARE: MR. RYAN WILLIAM FLANAGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	10554	GA
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477173920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN WILLIAM FLANAGAN

Provider Business Mailing Address
First Line	:	225 26TH ST NW APT 8408
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1901
Country	:	US
Telephone Number	:	631-807-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 MOUNT VERNON RD STE B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-4245
Country	:	US
Telephone Number	:	770-353-2001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	09/28/2022

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