Provider Demographics
NPI:1780390005
Name:MCCASKILL, ANGEL JOY
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:JOY
Last Name:MCCASKILL
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 1:1569 CULPEPPER LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6897
Mailing Address - Country:US
Mailing Address - Phone:248-460-3903
Mailing Address - Fax:
Practice Address - Street 1:1569 CULPEPPER LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6897
Practice Address - Country:US
Practice Address - Phone:248-460-3903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide