Provider Demographics
NPI:1639246366
Name:MONCADA, ARMANDO J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:J
Last Name:MONCADA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:134 ANSLEY DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1639
Mailing Address - Country:US
Mailing Address - Phone:800-507-0203
Mailing Address - Fax:800-507-0203
Practice Address - Street 1:134 ANSLEY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1614
Practice Address - Country:US
Practice Address - Phone:800-507-0203
Practice Address - Fax:800-507-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2017-04-06
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Provider Licenses
StateLicense IDTaxonomies
GA053337291U00000X, 207ZP0102X
FLME89563174400000X
LAMD07816R174400000X
TXH9386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No291U00000XLaboratoriesClinical Medical Laboratory
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA053337OtherLICENSE
GA383070886Medicaid
GA69WBDLWMedicare ID - Type Unspecified
GA383070886Medicaid