Provider Demographics
NPI:1700041175
Name:JOSE L. CANGIANO,M.D.,P.C.
Entity Type:Organization
Organization Name:JOSE L. CANGIANO,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:CANGIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-957-0898
Mailing Address - Street 1:3500 DULUTH PARK LN
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3242
Mailing Address - Country:US
Mailing Address - Phone:678-957-0898
Mailing Address - Fax:678-957-0939
Practice Address - Street 1:3500 DULUTH PARK LN
Practice Address - Street 2:SUITE 410
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3242
Practice Address - Country:US
Practice Address - Phone:678-957-0898
Practice Address - Fax:678-957-0939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0441822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG87807Medicare PIN