Provider Demographics
NPI:1871535849
Name:ANGSTADT, JOHN DAVID (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:ANGSTADT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-8712
Mailing Address - Fax:912-350-8753
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-8712
Practice Address - Fax:912-350-8753
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23552208600000X
GA050701208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG50701Medicaid
GA000932005AMedicaid
GA10063394OtherAMERIGROUP
GA349709OtherWELLCARE
GA020051364OtherRR MEDICARE
GA349709OtherWELLCARE
GA020051364OtherRR MEDICARE