Healthcare Provider Details

I. General information

NPI: 1285079723
Provider Name (Legal Business Name): ANGEL B MORALES-SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL WAY STE 270
SNELLVILLE GA
30078-2209
US

IV. Provider business mailing address

EMORY UNIVERSITY SCHOOL OF MEDICINE 615 MICHAEL STREET, SUITE 201
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 770-972-4780
  • Fax: 770-972-2371
Mailing address:
  • Phone: 404-727-5596
  • Fax: 404-727-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number18841
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18841
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number86159
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: