Provider Demographics
NPI:1679688220
Name:SANGMALEE, UMPON (MD)
Entity Type:Individual
Prefix:DR
First Name:UMPON
Middle Name:
Last Name:SANGMALEE
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 1:826 W ELM ST STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1727
Mailing Address - Country:US
Mailing Address - Phone:770-684-5348
Mailing Address - Fax:770-684-5348
Practice Address - Street 1:826 C WEST ELM ST
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-1727
Practice Address - Country:US
Practice Address - Phone:770-684-5348
Practice Address - Fax:770-684-5349
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA17081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00144834AMedicaid
GA00144834AMedicaid