Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 037264 | GA |
NPI | 1225048689 |
---|---|
Provider Name | Jonathan J Langberg |
First Address | Atlanta, GA 30322-1059 |
Second Address | Atlanta, GA 30322-1059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A52255 | (02) | GA |