Provider Demographics
NPI:1306838495
Name:LANGENBECK, DONALD F JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:F
Last Name:LANGENBECK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:STE 705
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:904-355-2136
Practice Address - Street 1:1901 PHOENIX BLVD
Practice Address - Street 2:STE 200
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5588
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:770-991-6477
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA33620208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0486290001OtherDME
GA00631067DMedicaid
GA00631067DMedicaid
RRBCB4505Medicare PIN
E44274Medicare UPIN