Provider Demographics
NPI:1417062530
Name:GRIFFIN, ANGELA PRAKASH (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PRAKASH
Last Name:GRIFFIN
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 1:2801 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-778-6400
Mailing Address - Fax:404-778-6426
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-778-6400
Practice Address - Fax:404-778-6426
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904357Medicaid
SCN01302Medicaid
SCN01302Medicaid
NC5904357Medicaid