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General NPI Number Information
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NPI Number | 1093820318
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Entity Type | Individual
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Provider Name | CLYDE T ANGEL DMIN
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1670 CLAIRMONT RD
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City | DECATUR
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State | GA
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Zip | 30033-4004
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Country | US
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Telephone | 404-321-6111
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Fax | 404-329-2235
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Provider Business Mailing Address
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Address Line | 6025 BRANDEN HILL LN
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City | BUFORD
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State | GA
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Zip | 30518-2225
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Country | US
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Telephone | 678-765-0019
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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