Provider Demographics
NPI:1265610109
Name:LANGFORD, GWENDOLYN FAY (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:FAY
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:231 GRAEFE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4222
Mailing Address - Country:US
Mailing Address - Phone:770-227-1587
Mailing Address - Fax:770-227-9459
Practice Address - Street 1:231 GRAEFE ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4222
Practice Address - Country:US
Practice Address - Phone:770-227-1587
Practice Address - Fax:770-227-1485
Is Sole Proprietor?:No
Enumeration Date:2008-02-02
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA4406363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant