1124174180 NPI number — DR. NICOLE T FLOWERS MD. MPH

Table of content: DR. NICOLE T FLOWERS MD. MPH (NPI 1124174180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124174180 NPI number — DR. NICOLE T FLOWERS MD. MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOWERS
Provider First Name:
NICOLE
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD. MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124174180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5358 OXFORD CHASE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNWOODY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30338-3082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-730-9179
Provider Business Mailing Address Fax Number:
770-488-5965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 HARDEE AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MCPHERSON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30330-1062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-464-0414
Provider Business Practice Location Address Fax Number:
404-464-0415
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD00037981 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)