Provider Demographics
NPI:1346231925
Name:LANG, WILLIAM COTTRELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COTTRELL
Last Name:LANG
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 1:3480 PRESTON RIDGE RD STE 600
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5462
Mailing Address - Country:US
Mailing Address - Phone:770-300-0101
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-352-0444
Practice Address - Fax:404-352-2529
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0125092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922061JMedicaid
GA300027801OtherRAILROAD MEDICARE
GAP00092169OtherRAILROAD MEDICARE
GA30DBJSXMedicare ID - Type Unspecified
GAE54658Medicare UPIN
GA30BDBCHMedicare ID - Type Unspecified