Organization Name: | LANGLEY FAMILY PRACTICE P A |
NPI Number: | 1255565255 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAWN TRACT LANGLEY (PHYSICIAN ASSISTANT) |
Mailing Address: | 22401 Andrew Jackson Hwy Maxton |
State: | NC US |
Postal Code: | 283646721 |
Phone Number: | 9108448150 |
Fax Number: | 9108448149 |
NPI Enumeration Date: | 05/06/2009 |
NPI Last Update Date: | 05/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 102637 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |