Provider Demographics
NPI:1669473245
Name:STILES, ANGELA G (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:STILES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3320 OLD JEFFERSON ROAD
Mailing Address - Street 2:BLDG 200 STE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-353-0636
Practice Address - Street 1:3320 OLD JEFFERSON ROAD
Practice Address - Street 2:BLDG 200 STE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-353-0636
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004008363AM0700X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA386137122AMedicaid
GAP89511Medicare UPIN
97WCGXNMedicare PIN