# LACANILAO MEDICAL MANAGEMENT PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kings Bay Family Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477698611
- **Authorized official:** DR. ANGELITO BUENCAMINO LACANILAO M.D. (PRESIDENT)
- **Authorized official phone:** (912) 882-5030

## Contact information

- **Practice address:** 340 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
- **Practice address phone:** (912) 882-5030
- **Practice address fax:** (888) 476-5235
- **Mailing address:** 340 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
- **Mailing address phone:** (912) 882-5030
- **Mailing address fax:** (888) 476-5235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 052769 | GA | Yes |

## Other

- **Enumeration date:** 02/21/2007
- **Last updated:** 12/20/2012