Healthcare Provider Details

I. General information

NPI: 1225048689
Provider Name (Legal Business Name): JONATHAN J LANGBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JONATHAN LANGBERG MD

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-5299
  • Fax:
Mailing address:
  • Phone: 404-778-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number037264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: