Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 58896 | GA |
NPI | 1407071822 |
---|---|
Provider Name | Latresa Lang |
First Address | Atlanta, GA 30328-4255 |
Second Address | Atlanta, GA 30328-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 25/06/2021 |