Provider Demographics
NPI:1467047639
Name:LANG, SUSAN LOUISE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LOUISE
Last Name:LANG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SATELLITE BLVD NW STE 400
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5299
Mailing Address - Country:US
Mailing Address - Phone:678-263-3080
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 400
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5299
Practice Address - Country:US
Practice Address - Phone:678-263-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN152597163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health