Provider Demographics
NPI:1023874971
Name:FLANAGAN, COLIN (PS-S)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:PS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CEDAR WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-9793
Mailing Address - Country:US
Mailing Address - Phone:631-807-5906
Mailing Address - Fax:
Practice Address - Street 1:150 CEDAR WOODS TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-9793
Practice Address - Country:US
Practice Address - Phone:631-807-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant