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Organization

ANGELITO HENRITO K JAO MD PC

Active
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Organization

ANGELITO HENRITO K JAO MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANGELITO HENRITO K JAO MD (PRESIDENT)
(770) 267-4711
Entity
Organization

Contact information

Practice address
333 ALCOVY ST, STE 3, MONROE, GA 30655-2180
(770) 267-4711
(770) 267-7320
Mailing address
PO BOX 1089, MONROE, GA 30655-1089
(770) 267-4711
(770) 267-7320

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
029685
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00349027A
GA
01
52237698001
BLUE CROSS/BLUE SHIELD
GA
01
905606
SOUTHCARE
Enumeration date
08/18/2005
Last updated
09/18/2007
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