Healthcare Provider Details

I. General information

NPI: 1447749288
Provider Name (Legal Business Name): AMIT PAUL JANGAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ASHVILLE AVE STE 330
CARY NC
27518-6134
US

IV. Provider business mailing address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

V. Phone/Fax

Practice location:
  • Phone: 919-371-2371
  • Fax: 919-371-2375
Mailing address:
  • Phone: 305-823-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2021-02196
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-02196
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: