Provider Demographics
NPI:1710177035
Name:GEOFFREY J FLATTMANN MD FACS PLLC
Entity Type:Organization
Organization Name:GEOFFREY J FLATTMANN MD FACS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLATTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-445-8667
Mailing Address - Street 1:1046 HIGHWAY 61 S
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8615
Mailing Address - Country:US
Mailing Address - Phone:601-442-8219
Mailing Address - Fax:
Practice Address - Street 1:142 JEFF DAVIS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5104
Practice Address - Country:US
Practice Address - Phone:601-445-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00322618OtherMEDICARE RAILROAD
LA1684147Medicaid
MS433474739BOtherBCBS OF MS
MS00122080Medicaid
LA4K041DE62Medicare PIN
MSG37315Medicare UPIN
MSP00322618OtherMEDICARE RAILROAD