Provider Demographics
NPI:1073595716
Name:ANGELETTI, CESAR AUGUSTO (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
Last Name:ANGELETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 AUSTELL RD
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1121
Mailing Address - Country:US
Mailing Address - Phone:470-732-3585
Mailing Address - Fax:470-732-3565
Practice Address - Street 1:3950 AUSTELL RD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1121
Practice Address - Country:US
Practice Address - Phone:470-732-3585
Practice Address - Fax:470-732-3565
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57347207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001423764Medicaid
I16075Medicare UPIN