Healthcare Provider Details

I. General information

NPI: 1437344603
Provider Name (Legal Business Name): ANGELA OANH PHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA OANH MCMILLEN M.D.

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DIXIE ST
CARROLLTON GA
30117-4417
US

IV. Provider business mailing address

100 PROFESSIONAL PL STE 204
CARROLLTON GA
30117-3802
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5831
  • Fax: 770-812-5832
Mailing address:
  • Phone: 770-812-5905
  • Fax: 770-838-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number62591
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: