Provider Demographics
NPI:1003556242
Name:ANGELES, JULIAN ALEXANDER
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:ALEXANDER
Last Name:ANGELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WHITCHER ST NE STE 2120
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1180
Mailing Address - Country:US
Mailing Address - Phone:770-423-0595
Mailing Address - Fax:678-391-5055
Practice Address - Street 1:61 WHITCHER ST NE STE 2120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1180
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:678-391-5055
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA206224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist