Provider Demographics
NPI:1689895336
Name:FLORES, GEYSA (PHD)
Entity Type:Individual
Prefix:
First Name:GEYSA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY STE 1903
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1237
Mailing Address - Country:US
Mailing Address - Phone:678-845-8596
Mailing Address - Fax:678-802-6985
Practice Address - Street 1:2450 ATLANTA HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8099
Practice Address - Country:US
Practice Address - Phone:678-845-8596
Practice Address - Fax:678-802-6985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8262103T00000X
GAPSY003665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003142155AMedicaid
FLW51349Medicare ID - Type Unspecified