Provider Demographics
NPI:1215321971
Name:ANGLYN, ADAM (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ANGLYN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SIMS ST
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2320
Mailing Address - Country:US
Mailing Address - Phone:770-957-3922
Mailing Address - Fax:770-957-5477
Practice Address - Street 1:55 SIMS ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2320
Practice Address - Country:US
Practice Address - Phone:770-957-3922
Practice Address - Fax:770-957-5477
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79930207R00000X
NC208316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine