Organization
FLEXOGENIX GEORGIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA FUENTES (CREDENTIALING COORDINATOR)
(213) 455-7803
Entity
Organization
Contact information
Practice address
4600 ROSWELL RD UNIT E210, SANDY SPRINGS, GA 30342-3197
(213) 455-7803
Mailing address
1000 S HOPE ST STE 101, LOS ANGELES, CA 90015-4057
(213) 455-7803
(213) 261-3816
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G707094
GEORGIA MEDICARE PTAN
GA
01
—
7628690001
MEDICARE NSC
GA
Enumeration date
02/21/2017
Last updated
10/30/2017
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