Provider Demographics
NPI:1619933421
Name:LANGTON, AMANDA MARKLEY (MED, ATC, NREMT-I)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARKLEY
Last Name:LANGTON
Suffix:
Gender:F
Credentials:MED, ATC, NREMT-I
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Mailing Address - Street 1:UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION
Mailing Address - Street 2:PO BOX 1472, 100 SMITH STREET
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603
Mailing Address - Country:US
Mailing Address - Phone:706-542-6936
Mailing Address - Fax:706-542-7707
Practice Address - Street 1:UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION, COLISEUM
Practice Address - Street 2:100 SMITH STREET
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30603-1472
Practice Address - Country:US
Practice Address - Phone:706-542-6936
Practice Address - Fax:706-542-7707
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAAT0007592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAT000759OtherLICENSE NUMBER