| Organization Name: | ANGUS LAKE INFUSION SERVICES |
| NPI Number: | 1063855211 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARL LAKE STANLEY (MEMBER) |
| Mailing Address: | 240 Milledgeville Rd Suite B Gordon |
| State: | GA US |
| Postal Code: | 310313827 |
| Phone Number: | 4783872399 |
| Fax Number: | 4786282263 |
| NPI Enumeration Date: | 04/08/2013 |
| NPI Last Update Date: | 10/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | PHHH000055 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |