MEDICARE: DR. DELIA L LANG PHD

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	103TC0700X	Clinical Psychologist	PSY002849	GA

General Provider Information

NPI Number	:	1376896696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DELIA L LANG PHD

Provider Business Mailing Address
First Line	:	182 IVY GLEN CIR
Second Line	:
City	:	AVONDALE ESTATES
State	:	GA
Zip	:	30002-1752
Country	:	US
Telephone Number	:	404-634-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 LAWRENCEVILLE HWY STE 200
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-3267
Country	:	US
Telephone Number	:	404-634-3400
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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Directions to “ DR. DELIA L LANG PHD” Practice Location

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