Provider Demographics
NPI:1659877264
Name:MOLE, ANGELIQUE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:A
Last Name:MOLE
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:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2344
Mailing Address - Country:US
Mailing Address - Phone:706-922-0600
Mailing Address - Fax:706-922-0603
Practice Address - Street 1:1226 DANTIGNAC ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2788
Practice Address - Country:US
Practice Address - Phone:706-922-0600
Practice Address - Fax:706-922-0603
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52682207Q00000X
GA88770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine