Healthcare Provider Details

I. General information

NPI: 1467701474
Provider Name (Legal Business Name): ANGELA DUGGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PROVIDENCE PARK DR E STE 102
MOBILE AL
36695-4618
US

IV. Provider business mailing address

7174 ASHTON CT
MOBILE AL
36695-4324
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-5070
  • Fax: 251-634-2994
Mailing address:
  • Phone: 251-752-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.848
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTA-1749
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: