Provider Demographics
NPI:1942944020
Name:AUSTIN, ANGEL ANN
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 COUNTY ROAD 57 S
Mailing Address - Street 2:
Mailing Address - City:NEWVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36353-6237
Mailing Address - Country:US
Mailing Address - Phone:478-696-0824
Mailing Address - Fax:
Practice Address - Street 1:8338 COUNTY ROAD 57 S
Practice Address - Street 2:
Practice Address - City:NEWVILLE
Practice Address - State:AL
Practice Address - Zip Code:36353-6237
Practice Address - Country:US
Practice Address - Phone:478-696-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health