Provider Demographics
NPI:1609056076
Name:AGRAIT, ANGELES (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELES
Middle Name:
Last Name:AGRAIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 MARISOL WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9061
Mailing Address - Country:US
Mailing Address - Phone:678-432-6471
Mailing Address - Fax:
Practice Address - Street 1:2737 MARISOL WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9061
Practice Address - Country:US
Practice Address - Phone:678-432-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002643171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor