Provider Demographics
NPI:1548817091
Name:FLEWELLEN, TONYA M
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:M
Last Name:FLEWELLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1472 COUNTRY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-6245
Mailing Address - Country:US
Mailing Address - Phone:770-904-4467
Mailing Address - Fax:
Practice Address - Street 1:1472 COUNTRY WOOD DR
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-6245
Practice Address - Country:US
Practice Address - Phone:770-904-4467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider