Healthcare Provider Details

I. General information

NPI: 1619933421
Provider Name (Legal Business Name): AMANDA MARKLEY LANGTON MED, ATC, NREMT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION, COLISEUM 100 SMITH STREET
ATHENS GA
30603-1472
US

IV. Provider business mailing address

UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION PO BOX 1472, 100 SMITH STREET
ATHENS GA
30603
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-6936
  • Fax: 706-542-7707
Mailing address:
  • Phone: 706-542-6936
  • Fax: 706-542-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000759
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: