Basic Information
| Provider Information | |||||||||
| NPI: | 1104882091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANGFORD | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 116156 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303686156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4703250136 | ||||||||
| FaxNumber: | 4703250191 | ||||||||
| Practice Location | |||||||||
| Address1: | 631 PROFESSIONAL DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300463367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783123500 | ||||||||
| FaxNumber: | 6783123529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 028181 | GA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 026201 | 01 | GA | BCBS EDI# | OTHER | 00482666A | 05 | GA | MEDICAID | 000482666B | 05 | GA | MEDICAID | 330003440 | 01 | GA | RRMEDICARE | OTHER |