Provider Demographics
NPI:1043407786
Name:PHILLIP R. LANGSDON MD FACS PLLC
Entity Type:Organization
Organization Name:PHILLIP R. LANGSDON MD FACS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGSDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-755-6465
Mailing Address - Street 1:7499 POPLAR PIKE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-5934
Mailing Address - Country:US
Mailing Address - Phone:901-755-6465
Mailing Address - Fax:901-757-5543
Practice Address - Street 1:7499 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-5934
Practice Address - Country:US
Practice Address - Phone:901-755-6465
Practice Address - Fax:901-757-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA98491Medicare UPIN
TN3021129Medicare PIN