Provider Demographics
NPI:1689867970
Name:LEO G FRANGIPANE JR. MD
Entity Type:Organization
Organization Name:LEO G FRANGIPANE JR. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRANGIPANE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-515-1090
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30539-0009
Mailing Address - Country:US
Mailing Address - Phone:706-515-1090
Mailing Address - Fax:706-515-1093
Practice Address - Street 1:765 MADDOX DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8189
Practice Address - Country:US
Practice Address - Phone:706-515-1090
Practice Address - Fax:706-515-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA196171338AMedicaid
GAGRP6187Medicare PIN