Provider Demographics
NPI:1245481068
Name:BRENT A FLICKINGER MD PC
Entity type:Organization
Organization Name:BRENT A FLICKINGER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLICKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-531-3711
Mailing Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LN NE
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2418
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:770-531-3718
Practice Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LN NE
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2418
Practice Address - Country:US
Practice Address - Phone:770-531-3711
Practice Address - Fax:770-531-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059065207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA747995060AMedicaid
GA747995060AMedicaid
66BBBJMMedicare PIN