MEDICARE: MRS. DONNA MARIA CREOLA LANG MPAS, PA-C

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	363AM0700X	Medical Physician Assistant
2	363AM0700X	Medical Physician Assistant	2564	OH
3	363AM0700X	Medical Physician Assistant	0010-01213	NC

General Provider Information

NPI Number	:	1639228679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA MARIA CREOLA LANG MPAS, PA-C

Provider Business Mailing Address
First Line	:	PO BOX 746746
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6746
Country	:	US
Telephone Number	:	866-680-8505
Fax Number	:	937-436-4156

Provider Business Practice Location Address
First Line	:	10502 PARK RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-6569
Country	:	US
Telephone Number	:	980-299-3926
Fax Number	:	980-299-6736

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/24/2026

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