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General NPI Number Information
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NPI Number | 1457757320
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Entity Type | Organization
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Legal Business Name | JERRY H. LANGFORD
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 1100 HALLE PARK CIR SUITE101
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City | COLLIERVILLE
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State | TN
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Zip | 38017-7178
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Country | US
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Telephone | 901-853-1574
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Fax | 901-861-0839
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Provider Business Mailing Address
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Address Line | 1100 HALLE PARK CIR SUITE101
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City | COLLIERVILLE
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State | TN
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Zip | 38017-7178
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Country | US
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Telephone | 901-853-1574
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Fax | 901-861-0839
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROL LANGFORD
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Credential |
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Telephone | 901-853-1574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 164
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License Number State | TN
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