Individual
DR. ANGIE RENEE HAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-2273
(762) 408-8300
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-2273
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
059765
GA
207Q00000X
Family Medicine Physician
59765
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068846053D
—
GA
01
—
202I089077
MEDICARE PTAN
GA
Enumeration date
10/24/2006
Last updated
02/18/2025
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