Provider Demographics
NPI:1497299440
Name:ANGELIC CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ANGELIC CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:STANETRICE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:754-224-9512
Mailing Address - Street 1:1500 JUNEAU WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-2962
Mailing Address - Country:US
Mailing Address - Phone:770-568-2777
Mailing Address - Fax:678-819-0877
Practice Address - Street 1:1500 JUNEAU WAY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-2962
Practice Address - Country:US
Practice Address - Phone:770-568-2777
Practice Address - Fax:678-819-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care