Provider Demographics
NPI:1003937145
Name:LANGSTON, LORAINE
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:
Last Name:LANGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 GLEN BRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8399
Mailing Address - Country:US
Mailing Address - Phone:770-374-2671
Mailing Address - Fax:770-808-6623
Practice Address - Street 1:2243 GLEN BRIAR WAY
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8399
Practice Address - Country:US
Practice Address - Phone:770-374-2671
Practice Address - Fax:770-808-6623
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator