Provider Demographics
NPI:1710303847
Name:FLOURNOY, EVALENE
Entity Type:Individual
Prefix:
First Name:EVALENE
Middle Name:
Last Name:FLOURNOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:31833-5001
Mailing Address - Country:US
Mailing Address - Phone:706-882-1183
Mailing Address - Fax:
Practice Address - Street 1:5365 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:GA
Practice Address - Zip Code:31833-5001
Practice Address - Country:US
Practice Address - Phone:706-882-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCH006438311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home