Provider Demographics
NPI:1801117312
Name:WITTE, ANGELA CRENSHAW
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CRENSHAW
Last Name:WITTE
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 1:2815 CREEKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-2422
Mailing Address - Country:US
Mailing Address - Phone:706-718-5181
Mailing Address - Fax:
Practice Address - Street 1:2815 CREEKSTONE LN
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-2422
Practice Address - Country:US
Practice Address - Phone:706-718-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator