Provider Demographics
NPI:1124005541
Name:ANGEL, ALANNA E (MD PHD)
Entity Type:Individual
Prefix:MRS
First Name:ALANNA
Middle Name:E
Last Name:ANGEL
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:MS
Other - First Name:ALANNA
Other - Middle Name:E
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639-0638
Mailing Address - Country:US
Mailing Address - Phone:864-379-2345
Mailing Address - Fax:864-379-3228
Practice Address - Street 1:6 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639-9554
Practice Address - Country:US
Practice Address - Phone:864-379-2345
Practice Address - Fax:864-379-3228
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCLL4403Medicaid
SCLL4403Medicaid