Provider Demographics
NPI:1679272363
Name:FLUKER, COREY
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:
Last Name:FLUKER
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 1:4825 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-5874
Mailing Address - Country:US
Mailing Address - Phone:706-306-1177
Mailing Address - Fax:706-751-2829
Practice Address - Street 1:4825 JASMINE WAY
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-5874
Practice Address - Country:US
Practice Address - Phone:706-306-1177
Practice Address - Fax:706-751-2829
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)