Individual
LANGSTON B CLEVELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4468 UNION RD, TIFTON, GA 31794-8331
(229) 353-6320
(229) 353-6343
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 353-6320
(229) 353-6343
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046584
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000820069B
—
GA
01
—
046584
STATE LICENSE NUMBER
GA
Enumeration date
11/15/2006
Last updated
11/30/2020
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