Healthcare Provider Details

I. General information

NPI: 1366534851
Provider Name (Legal Business Name): MICHAEL F ANGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PKWY NE STE. 220A
GAINESVILLE GA
30501-3801
US

IV. Provider business mailing address

925 N POINT PKWY STE. 130
ALPHARETTA GA
30005-5210
US

V. Phone/Fax

Practice location:
  • Phone: 678-206-2700
  • Fax: 678-696-2328
Mailing address:
  • Phone: 678-206-2589
  • Fax: 678-261-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number77529
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number77529
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: