Provider Demographics
NPI:1487755724
Name:CANGIANO, JOSE LUCAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUCAS
Last Name:CANGIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500 DULUTH PARK LN
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3242
Mailing Address - Country:US
Mailing Address - Phone:678-957-0898
Mailing Address - Fax:678-957-0939
Practice Address - Street 1:240 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2043
Practice Address - Country:US
Practice Address - Phone:855-333-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0441822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00889094BMedicaid
GA26BDHSQMedicare ID - Type Unspecified
GA00889094BMedicaid