Provider Demographics
NPI:1255421475
Name:FLORENTINO, FRANCES T (MD)
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:T
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 WILLIAMSBURG WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-922-3376
Mailing Address - Fax:706-922-5643
Practice Address - Street 1:1002 WILLIAMSBURG WAY
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-922-3376
Practice Address - Fax:706-922-5643
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057616207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52210113-001OtherBCBS GA
GA239541908AMedicaid
SCG57616Medicaid
GA239541908AMedicaid
GA07BBSTHMedicare PIN