Angeles Agrait, PT
Individual provider Active NPI Contractor · McDonough, GA
NPI 1609056076 · NPPES record last updated Nov 14, 2007
Key facts
- NPI
- 1609056076
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- PT002643 (GA)
- Practice address
- 2737 Marisol Way
McDonough, GA 30253-9061 - Phone
- (678) 432-6471
- NPI assigned
- Nov 14, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT002643 | GA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | PT002643 | GA | Yes |
Addresses
Primary practice location
2737 Marisol Way
McDonough, GA 30253-9061
Mailing address
2737 Marisol Way
McDonough, GA 30253-9061
Phone (678) 432-6471
Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.