Provider Demographics
NPI:1831589100
Name:HASTY, ANGEL (NP-C)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:HASTY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1587
Mailing Address - Country:US
Mailing Address - Phone:706-529-7440
Mailing Address - Fax:706-529-7437
Practice Address - Street 1:1012 BURLEYSON RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8340
Practice Address - Country:US
Practice Address - Phone:706-529-3245
Practice Address - Fax:706-272-6077
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA197661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily