Provider Demographics
NPI:1265525141
Name:LANGLOIS, DAVID (PAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LANGLOIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2588
Mailing Address - Country:US
Mailing Address - Phone:706-226-5533
Mailing Address - Fax:706-529-5858
Practice Address - Street 1:1104 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2588
Practice Address - Country:US
Practice Address - Phone:706-226-5533
Practice Address - Fax:706-529-5858
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000524BMedicaid
GAR68886Medicare UPIN
GA97WCGNXMedicare ID - Type Unspecified