Healthcare Provider Details

I. General information

NPI: 1376753046
Provider Name (Legal Business Name): DAWN TRACY LANGLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 OAKRIDGE BLVD STE A3
LUMBERTON NC
28358-2351
US

IV. Provider business mailing address

2002 N CEDAR ST STE B
LUMBERTON NC
28358-3926
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-1141
  • Fax: 910-738-6011
Mailing address:
  • Phone: 910-272-3048
  • Fax: 910-738-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberNC102637
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: