Healthcare Provider Details

I. General information

NPI: 1992705131
Provider Name (Legal Business Name): DEANINE M ANGOTTI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANINE DECKER PA

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-9000
  • Fax:
Mailing address:
  • Phone: 770-282-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10933
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10933
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: