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General NPI Number Information
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NPI Number | 1346082559
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Entity Type | Individual
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Provider Name | CHARLOTTE SELENE ANGUIANO PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/10/2024
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 975 JOHNSON FY RD NE STE 400
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City | ATLANTA
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State | GA
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Zip | 30342-4736
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Country | US
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Telephone | 205-394-5149
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Fax |
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Provider Business Mailing Address
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Address Line | 2632 PEACHTREE RD NW APT A104
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City | ATLANTA
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State | GA
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Zip | 30305-3612
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Country | US
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Telephone | 205-310-9903
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12837
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License Number State | GA
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