Provider Demographics
NPI:1336582329
Name:OLANGO, WEREDESELAM MENNA (MD)
Entity Type:Individual
Prefix:DR
First Name:WEREDESELAM
Middle Name:MENNA
Last Name:OLANGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 MEDICAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4145
Mailing Address - Country:US
Mailing Address - Phone:214-576-6284
Mailing Address - Fax:706-845-3754
Practice Address - Street 1:303 MEDICAL DR STE 401
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:214-576-6284
Practice Address - Fax:706-845-3754
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA797692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program