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General NPI Number Information
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NPI Number | 1053375311
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Entity Type | Individual
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Provider Name | MICHELE A AGUAYO MD
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 2594 LOGANVILLE HWY
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City | GRAYSON
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State | GA
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Zip | 30017-1617
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Country | US
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Telephone | 678-225-4999
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Fax | 678-225-5546
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Provider Business Mailing Address
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Address Line | 2594 LOGANVILLE HWY
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City | GRAYSON
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State | GA
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Zip | 30017-1617
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Country | US
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Telephone | 678-225-4999
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Fax | 678-225-5546
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036490
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License Number State | GA
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