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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