Provider Demographics
NPI:1376089342
Name:HEAD, ANGELA (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 ABERCORN ST
Mailing Address - Street 2:SUITE 129
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5713
Mailing Address - Country:US
Mailing Address - Phone:912-335-1699
Mailing Address - Fax:912-335-1352
Practice Address - Street 1:6555 ABERCORN ST
Practice Address - Street 2:SUITE 129
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5713
Practice Address - Country:US
Practice Address - Phone:912-335-1699
Practice Address - Fax:912-335-1352
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA078771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse