Provider Demographics
NPI:1255565255
Name:LANGLEY FAMILY PRACTICE P A
Entity type:Organization
Organization Name:LANGLEY FAMILY PRACTICE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:TRACT
Authorized Official - Last Name:LANGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-844-8150
Mailing Address - Street 1:22401 ANDREW JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-6721
Mailing Address - Country:US
Mailing Address - Phone:910-844-8150
Mailing Address - Fax:910-844-8149
Practice Address - Street 1:22401 ANDREW JACKSON HWY
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-6721
Practice Address - Country:US
Practice Address - Phone:910-844-8150
Practice Address - Fax:910-844-8149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP70657Medicare UPIN