Provider Demographics
NPI:1639130453
Name:TAGOE, ALBERT TEIKO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:TEIKO
Last Name:TAGOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COUNTRY CLUB DR STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9089
Mailing Address - Country:US
Mailing Address - Phone:770-474-3882
Mailing Address - Fax:770-474-9392
Practice Address - Street 1:150 COUNTRY CLUB DR STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9089
Practice Address - Country:US
Practice Address - Phone:770-474-3882
Practice Address - Fax:404-420-2091
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA337202086S0129X
GA0337202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000443198DMedicaid
GA00443198CMedicaid
GAF53823Medicare UPIN