Provider Demographics
NPI:1174127617
Name:FLUHARTY, KYLE
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:FLUHARTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 ASHFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5539
Mailing Address - Country:US
Mailing Address - Phone:567-224-8491
Mailing Address - Fax:
Practice Address - Street 1:214 WALLER AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2747
Practice Address - Country:US
Practice Address - Phone:864-543-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT00330152W00000X
SC2287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist