Provider Demographics
NPI:1356341614
Name:LANGLO, GUY HARRIS (DPM)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:HARRIS
Last Name:LANGLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3874
Mailing Address - Country:US
Mailing Address - Phone:770-834-9080
Mailing Address - Fax:770-834-2488
Practice Address - Street 1:100 PROFESSIONAL PL
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3874
Practice Address - Country:US
Practice Address - Phone:770-834-9080
Practice Address - Fax:770-834-2488
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000774213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000701445AMedicaid
480020214OtherRR MCR
48SCBRGMedicare PIN
480020214OtherRR MCR
GAU61457Medicare UPIN