Provider Demographics
NPI:1083949267
Name:LONG, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:210 E DERENNE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:503 EISENHOWER DRIVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-355-6255
Practice Address - Fax:912-355-6256
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2019-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS200742085R0202X
TN453832085R0202X
GA0-682372085R0202X
SCTL-350812085R0202X
GA0682372085R0202X
NC2011-008942085R0202X
ARE-62702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003125154AMedicaid
GA2021300321OtherMEDICARE/PTAN
GA003125154AOtherGEORGIA MEDICAID/PEACHCARE FOR KIDS PROGRAM