Provider Demographics
NPI:1306275813
Name:FLAGG, ERNEST GRANT (RN)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:GRANT
Last Name:FLAGG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4525 FLAT SHOALS PKWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5038
Mailing Address - Country:US
Mailing Address - Phone:404-600-8675
Mailing Address - Fax:800-766-1168
Practice Address - Street 1:4525 FLAT SHOALS PKWY
Practice Address - Street 2:SUITE 401
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5038
Practice Address - Country:US
Practice Address - Phone:404-600-8675
Practice Address - Fax:800-766-1168
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2015-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI4704299244163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst