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General NPI Number Information
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NPI Number | 1093571119
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Entity Type | Individual
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Provider Name | ANGILOO GRECIA
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Gender | Female
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 655 WILLOWWIND DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-5704
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Country | US
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Telephone | 470-930-4038
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 WOODMONT LN NW # 2065
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City | ATLANTA
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State | GA
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Zip | 30318-2866
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Country | US
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Telephone | 470-930-4038
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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