Provider Demographics
NPI:1720365893
Name:FLOWERS, RONALD LLEWELLYN
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LLEWELLYN
Last Name:FLOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:LLEWELLYN
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:882 PROFFITT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-1711
Mailing Address - Country:US
Mailing Address - Phone:865-898-1570
Mailing Address - Fax:
Practice Address - Street 1:9135 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1425
Practice Address - Country:US
Practice Address - Phone:865-558-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN139363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical