MEDICARE: ANGELA ELIZABETH NYE

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
1	2085R0202X	Diagnostic Radiology Physician	512318	GA

General Provider Information

NPI Number	:	1497601769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ELIZABETH NYE

Provider Business Mailing Address
First Line	:	90 SCOUT HUT RD
Second Line	:
City	:	DANIELSVILLE
State	:	GA
Zip	:	30633-7070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 TANNERS CREEK DR
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-2816
Country	:	US
Telephone Number	:	404-321-6111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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