Provider Demographics
NPI:1780670554
Name:FALANY, ANGELA FAYE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:FAYE
Last Name:FALANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:FAYE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 TOWNE LAKE PKWY
Mailing Address - Street 2:STE 404
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188
Mailing Address - Country:US
Mailing Address - Phone:770-926-9229
Mailing Address - Fax:678-415-2164
Practice Address - Street 1:900 TOWNE LAKE PKWY
Practice Address - Street 2:STE 404
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188
Practice Address - Country:US
Practice Address - Phone:770-926-9229
Practice Address - Fax:678-415-2164
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040057207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0008170550Medicaid
GA000817055LMedicaid
GA202I163403Medicare PIN
GA0008170550Medicaid