Provider Demographics
NPI:1821046814
Name:FLYNN, HERBERT EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:EUGENE
Last Name:FLYNN
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 1:3211 SHANNON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6322
Mailing Address - Country:US
Mailing Address - Phone:800-291-4020
Mailing Address - Fax:919-419-7247
Practice Address - Street 1:2855 OLD HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6248
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:919-419-7247
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52929207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E77902Medicare UPIN