Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN014643 | GA |
NPI | 1033553151 |
---|---|
Provider Name | Megan Powers Flournoy |
First Address | Macon, GA 31210-2910 |
Second Address | Macon, GA 31210-6565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2013 |
Last Update Date | 27/07/2015 |