Provider Demographics
NPI:1093276388
Name:SWEET, ANGELA KIM (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KIM
Last Name:SWEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E SOMMER OAK DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8562
Mailing Address - Country:US
Mailing Address - Phone:770-905-0211
Mailing Address - Fax:
Practice Address - Street 1:301 ANDERSON ROAD
Practice Address - Street 2:
Practice Address - City:DALEVILL
Practice Address - State:AL
Practice Address - Zip Code:36322
Practice Address - Country:US
Practice Address - Phone:334-255-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL123456OtherPRIVATE PRACTICE