Provider Demographics
NPI:1386606283
Name:LANGELLA, ROSA L (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:L
Last Name:LANGELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:80 INTERSTATE SOUTH DR
Mailing Address - Street 2:STE B
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-6226
Mailing Address - Country:US
Mailing Address - Phone:706-692-9081
Mailing Address - Fax:706-692-0155
Practice Address - Street 1:80 INTERSTATE SOUTH DR
Practice Address - Street 2:STE B
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-6226
Practice Address - Country:US
Practice Address - Phone:706-692-9081
Practice Address - Fax:706-692-0155
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA047613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00832477AMedicaid
GAG55987Medicare UPIN
GA00832477AMedicaid