Provider Demographics
NPI:1821410630
Name:LANGSTON, MICHAEL ANTHONY SR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:LANGSTON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:JULIET
Other - Middle Name:
Other - Last Name:LANGSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:905 OGLETHORPE LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7908
Mailing Address - Country:US
Mailing Address - Phone:469-337-4817
Mailing Address - Fax:469-481-2642
Practice Address - Street 1:905 OGLETHORPE LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TX
Practice Address - Zip Code:76227-7908
Practice Address - Country:US
Practice Address - Phone:469-337-4817
Practice Address - Fax:469-481-2642
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health