Individual
JACQUELINE NICOLE FLANDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1150 BROOKSTONE CENTRE PKWY, COLUMBUS, GA 31904-4577
(706) 257-4189
(706) 257-4194
Mailing address
835 COGBURN AVE NW STE 250, MARIETTA, GA 30060-1056
(770) 422-8815
(770) 422-8816
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
070111
GA
207N00000X
Dermatology Physician
70111
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003159653A
—
GA
01
—
202G708679
MEDICARE PTAN
GA
Enumeration date
04/13/2009
Last updated
06/17/2020
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