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NPI Code Detail

MEDICARE: DR. JOSE LUCAS CANGIANO M.D.

MEDICARE: DR. JOSE LUCAS CANGIANO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician044182GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487755724
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE LUCAS CANGIANO M.D.
Provider Business Mailing Address
First Line : 3500 DULUTH PARK LN
Second Line : SUITE 410
City : DULUTH
State : GA
Zip : 30096-3242
Country : US
Telephone Number : 678-957-0898
Fax Number : 678-957-0939
Provider Business Practice Location Address
First Line : 240 MITCHELL BRIDGE RD
Second Line :
City : ATHENS
State : GA
Zip : 30606-2043
Country : US
Telephone Number : 855-333-9544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 11/20/2019

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