Provider Demographics
NPI:1124197546
Name:FLANIGAN, JAMES R (SWLC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:FLANIGAN
Suffix:
Gender:M
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HUNNICUTT DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-1707
Mailing Address - Country:US
Mailing Address - Phone:706-548-8846
Mailing Address - Fax:706-549-8000
Practice Address - Street 1:215 HUNNICUTT DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1707
Practice Address - Country:US
Practice Address - Phone:706-548-8846
Practice Address - Fax:706-549-8000
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW00232101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFRBMedicare ID - Type Unspecified