Provider Demographics
NPI:1851593552
Name:ANG, GREGORY BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BENJAMIN
Last Name:ANG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:THE SOUTHEAST PERMANENTE MEDICAL GROUP
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:404-250-6405
Practice Address - Street 1:20 GLENLAKE PKWY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE MEDICAL OFFICE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:404-250-6400
Practice Address - Fax:404-250-6405
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2022-01-13
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Provider Licenses
StateLicense IDTaxonomies
NC200300550207RC0000X
GA59361207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526802771AMedicaid
GA526802771BMedicaid
GA526802771AMedicaid
GA511I060042Medicare PIN