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General NPI Number Information
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NPI Number | 1033738570
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Entity Type | Individual
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Provider Name | ANGEL THOMAS ARDMS, RVT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 04/26/2020
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Provider Practice Location Address
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Address Line | 21 LAKE SHORE BLVD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-3612
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Country | US
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Telephone | 912-704-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 21 LAKE SHORE BLVD
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-3612
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Country | US
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Telephone | 912-704-1053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 134297
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License Number State | GA
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