MEDICARE: MRS. JACQUELINE HOOKS LANGSTON CNM

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	367A00000X	Advanced Practice Midwife	2392	NC

General Provider Information

NPI Number	:	1316017619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE HOOKS LANGSTON CNM

Provider Business Mailing Address
First Line	:	546 RAYS RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-3143
Country	:	US
Telephone Number	:	404-299-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 HARDEE AVE SW
Second Line	:
City	:	FT. MCPHERSON
State	:	GA
Zip	:	30330-1062
Country	:	US
Telephone Number	:	404-464-0320
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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