Healthcare Provider Details

I. General information

NPI: 1649125295
Provider Name (Legal Business Name): MR. CLIFFORD BRANDON LE LANGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 REFORMATION PKWY STE 200
CANTON GA
30114-2915
US

IV. Provider business mailing address

1000 VIEW DR UNIT 1102
WOODSTOCK GA
30189-5290
US

V. Phone/Fax

Practice location:
  • Phone: 470-243-4430
  • Fax: 844-749-1928
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP278773
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: