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General NPI Number Information
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NPI Number | 1649055864
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Entity Type | Individual
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Provider Name | JOHN FREDERICK AGEL JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 1777 NORTHEAST EXPY NE STE 160
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2480
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Country | US
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Telephone | 404-520-6608
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Fax |
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Provider Business Mailing Address
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Address Line | 2080 SILVER HILL RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-1731
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Country | US
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Telephone | 404-520-6608
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 028366
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License Number State | GA
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