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General NPI Number Information
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NPI Number | 1821410630
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Entity Type | Individual
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Provider Name | MR. MICHAEL ANTHONY LANGSTON SR.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 905 OGLETHORPE LN
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City | SAVANNAH
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State | TX
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Zip | 76227-7908
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Country | US
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Telephone | 469-337-4817
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Fax | 469-481-2642
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Provider Business Mailing Address
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Address Line | 905 OGLETHORPE LN
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City | SAVANNAH
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State | TX
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Zip | 76227-7908
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Country | US
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Telephone | 469-337-4817
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Fax | 469-481-2642
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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