Healthcare Provider Details

I. General information

NPI: 1396676334
Provider Name (Legal Business Name): XAVIER KENARRD LANGSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

2593 CARNES CROSSING WAY
JONESBORO GA
30236-6276
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5914
  • Fax:
Mailing address:
  • Phone: 770-655-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberLANG-CYXEQ1
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: