Healthcare Provider Details

I. General information

NPI: 1407071822
Provider Name (Legal Business Name): LATRESA LANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 MOUNT VERNON HWY NE STE 300
ATLANTA GA
30328-4255
US

IV. Provider business mailing address

859 MOUNT VERNON HWY NE STE 300
ATLANTA GA
30328-4255
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-0588
  • Fax: 404-785-0596
Mailing address:
  • Phone: 404-785-0588
  • Fax: 404-785-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number58896
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: