Provider Demographics
NPI:1447712252
Name:FLYNN, DAVID MARCOS (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARCOS
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 MEADOWVIEW DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-4324
Mailing Address - Country:US
Mailing Address - Phone:912-660-1882
Mailing Address - Fax:
Practice Address - Street 1:2466 LADD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78236-5310
Practice Address - Country:US
Practice Address - Phone:912-660-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004988133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered