Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 018296 | GA |
NPI | 1003843988 |
---|---|
Provider Name | Dr. Clarence Flanigan JR. |
First Address | Augusta, GA 30909-6050 |
Second Address | Washington, GA 30673-1602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B92309 | (02) | GA |