Provider Demographics
NPI:1124183306
Name:JAMES HERRY, ANGELICA G (MD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:G
Last Name:JAMES HERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:G
Other - Last Name:JAMES-HERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1405 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1060
Mailing Address - Country:US
Mailing Address - Phone:404-785-1112
Mailing Address - Fax:404-785-6288
Practice Address - Street 1:1405 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1060
Practice Address - Country:US
Practice Address - Phone:404-785-1112
Practice Address - Fax:404-785-6288
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA483622080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38892Medicare UPIN