Provider Demographics
NPI:1801845136
Name:FLATTMANN, GEOFFREY J (MD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:J
Last Name:FLATTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JEFF DAVIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5104
Mailing Address - Country:US
Mailing Address - Phone:160-144-5866
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:601-445-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684147Medicaid
LA022612OtherMEDICAL LICENSE
MS00122080Medicaid
MS16771OtherMEDICAL LICENSE
MS16771OtherMEDICAL LICENSE
MSG37315Medicare UPIN
LA1684147Medicaid