Provider Demographics
NPI:1386406494
Name:FLOWERS, JERREAM C
Entity type:Individual
Prefix:
First Name:JERREAM
Middle Name:C
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JERREAM
Other - Middle Name:C
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DRIVER
Mailing Address - Street 1:876 BRANDY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:STONE MTN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2025
Mailing Address - Country:US
Mailing Address - Phone:404-454-1306
Mailing Address - Fax:
Practice Address - Street 1:876 BRANDY OAKS LN
Practice Address - Street 2:
Practice Address - City:STONE MTN
Practice Address - State:GA
Practice Address - Zip Code:30088-2025
Practice Address - Country:US
Practice Address - Phone:404-454-1306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052358496172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty