MEDICARE: FLAGLER MEDICAL CENTER, INC.

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1568604627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLAGLER MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	2020 HOWELL MILL RD NW
Second Line	:	SUITE C-346
City	:	ATLANTA
State	:	GA
Zip	:	30318-1732
Country	:	US
Telephone Number	:	678-237-6448
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 HOWELL MILL RD NW
Second Line	:	SUITE C-346
City	:	ATLANTA
State	:	GA
Zip	:	30318-1732
Country	:	US
Telephone Number	:	678-237-6448
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. REYNIER SANTOS
Credential	:
Telephone Number	:	678-237-6448

Provider Enumeration Date	:	04/03/2009
Last Update Date	:	04/03/2009

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