Provider Demographics
NPI:1285756163
Name:HARRELL, JUSTIN FLYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:FLYNN
Last Name:HARRELL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:200 DOCTORS DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2203
Mailing Address - Country:US
Mailing Address - Phone:912-384-3338
Mailing Address - Fax:912-384-8214
Practice Address - Street 1:200 DOCTORS DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2203
Practice Address - Country:US
Practice Address - Phone:912-384-3338
Practice Address - Fax:912-384-8214
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA59162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA870694111CMedicaid
GA059162OtherSTATE MEDICAL LICENSE
GA202I6086025Medicare PIN