Provider Demographics
NPI:1003245473
Name:FLYNN, ANN MARIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 MILL TRACE CT
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-2724
Mailing Address - Country:US
Mailing Address - Phone:404-808-0591
Mailing Address - Fax:
Practice Address - Street 1:5565 MILL TRACE CT
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-2724
Practice Address - Country:US
Practice Address - Phone:404-808-0591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005396171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor