Provider Demographics
NPI:1083171581
Name:LANGLEY, ALICIA HAWKINS (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:HAWKINS
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:DANIELLE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4745 ASHFORD DUNWOODY RD STE D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5574
Mailing Address - Country:US
Mailing Address - Phone:678-254-0945
Mailing Address - Fax:
Practice Address - Street 1:4745 ASHFORD DUNWOODY RD STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5574
Practice Address - Country:US
Practice Address - Phone:678-254-0945
Practice Address - Fax:678-254-0943
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1822014OtherWELLCARE
GA06711225OtherAMERIGROUP
GA003216028AMedicaid