Provider Demographics
NPI:1700878469
Name:JAO, ANGELITO HENRITO K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELITO
Middle Name:HENRITO K
Last Name:JAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1089
Mailing Address - Country:US
Mailing Address - Phone:770-267-4711
Mailing Address - Fax:770-267-7320
Practice Address - Street 1:333 ALCOVY ST
Practice Address - Street 2:STE 3
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2180
Practice Address - Country:US
Practice Address - Phone:770-267-4711
Practice Address - Fax:770-267-7320
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA029685207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401132OtherUNITED HEALTHCARE
GA00349027AMedicaid
GA52237698 001OtherBLUE CROSS/BLUE SHIELD
GA00349027AMedicaid