Healthcare Provider Details

I. General information

NPI: 1538467014
Provider Name (Legal Business Name): ANGELO GALANTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 FERST DR
ATLANTA GA
30332
US

IV. Provider business mailing address

740 FERST DRIVE
ATLANTA GA
30332-0470
US

V. Phone/Fax

Practice location:
  • Phone: 404-894-1423
  • Fax:
Mailing address:
  • Phone: 404-894-1423
  • Fax: 404-385-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036976
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: