Provider Demographics
NPI:1568402162
Name:FLACKER, JONATHAN MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MARSHALL
Last Name:FLACKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMMA I DARNELL GERIATRICS CENTER
Mailing Address - Street 2:80 JESSE HILL JR DRIVE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-7642
Mailing Address - Fax:404-616-2474
Practice Address - Street 1:1331 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2357
Practice Address - Country:US
Practice Address - Phone:770-629-3217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048148207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA048148OtherSTATE LICENSE NUMBER
GA048148OtherSTATE LICENSE NUMBER