Provider Demographics
NPI:1033553151
Name:FLOURNOY, MEGAN POWERS
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:POWERS
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 TROON WAY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2910
Mailing Address - Country:US
Mailing Address - Phone:770-364-3429
Mailing Address - Fax:
Practice Address - Street 1:5437 BOWMAN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-6565
Practice Address - Country:US
Practice Address - Phone:478-333-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0146431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry