MEDICARE: MS. NICHOLE J LANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	91658	GA
2	207P00000X	Emergency Medicine Physician	63754	TN
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1275802654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICHOLE J LANG

Provider Business Mailing Address
First Line	:	170 PLEASANT ST.
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02719-2505
Country	:	US
Telephone Number	:	508-558-4305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 MARYLAND WAY STE 300
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7516
Country	:	US
Telephone Number	:	855-246-8607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	06/15/2022

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