Healthcare Provider Details

I. General information

NPI: 1346878261
Provider Name (Legal Business Name): SERGIO ESTEBAN ANGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 CAIN CIR STE 120
DACULA GA
30019-1658
US

IV. Provider business mailing address

3640 MUNDY MILL RD STE 112
GAINESVILLE GA
30504-8201
US

V. Phone/Fax

Practice location:
  • Phone: 877-549-4633
  • Fax:
Mailing address:
  • Phone: 877-549-4633
  • Fax: 678-968-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96937
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number96937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: