Organization
LACANILAO MEDICAL MANAGEMENT PC
Active
Other names
Kings Bay Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELITO BUENCAMINO LACANILAO M.D. (PRESIDENT)
(912) 882-5030
Entity
Organization
Contact information
Practice address
340 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
(912) 882-5030
(888) 476-5235
Mailing address
340 CHARLIE SMITH SR HWY, SAINT MARYS, GA 31558-3101
(912) 882-5030
(888) 476-5235
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
052769
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083558714B
—
GA
01
—
1477698611
NPI
GA
01
—
GRP6277
MEDICARE PTAN
GA
Enumeration date
02/21/2007
Last updated
12/20/2012
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