Provider Demographics
NPI:1548226129
Name:LANGSHAW, JOSEPH P (PA C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:LANGSHAW
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:P
Other - Last Name:LANGSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-272-3512
Practice Address - Street 1:1035 RED BUD RD NE
Practice Address - Street 2:SUITE 205
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-6008
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:706-272-3512
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004638363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA842043546AMedicaid
GA97WCHDSMedicare ID - Type Unspecified
Q58575Medicare UPIN