1548226129 NPI number — MR. JOSEPH P LANGSHAW PA C

Table of content: MR. JOSEPH P LANGSHAW PA C (NPI 1548226129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548226129 NPI number — MR. JOSEPH P LANGSHAW PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGSHAW
Provider First Name:
JOSEPH
Provider Middle Name:
P
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGSHAW
Provider Other First Name:
JOSEPH
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PAC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548226129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30720-8662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-277-7311
Provider Business Mailing Address Fax Number:
706-272-3512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 RED BUD RD NE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30701-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-277-7311
Provider Business Practice Location Address Fax Number:
706-272-3512
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  004638 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 842043546A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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