Provider Demographics
NPI:1003366303
Name:D'ANGELO, MARIA (PHYSICIAN ASSISTAT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 NEWNAN CROSSING BLVD E STE G
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6601
Mailing Address - Country:US
Mailing Address - Phone:404-640-8416
Mailing Address - Fax:678-633-3501
Practice Address - Street 1:1741 NEWNAN CROSSING BLVD E STE G
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6601
Practice Address - Country:US
Practice Address - Phone:404-640-8416
Practice Address - Fax:678-633-3501
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant