Provider Demographics
NPI:1700417714
Name:LANGLOIS, LISA NICOLE (CAA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:LANGLOIS
Suffix:
Gender:F
Credentials:CAA
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Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY STE 304
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6325 HOSPITAL PKWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5775
Practice Address - Country:US
Practice Address - Phone:678-474-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant