Provider Demographics
NPI:1104858489
Name:LONG, WILLIAM H III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:LONG
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:H
Other - Last Name:LONG
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:420 W CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4524
Mailing Address - Country:US
Mailing Address - Phone:843-917-4977
Mailing Address - Fax:843-639-8145
Practice Address - Street 1:420 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4524
Practice Address - Country:US
Practice Address - Phone:843-917-4977
Practice Address - Fax:843-917-4968
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC231966Medicaid
SCH70414Medicare UPIN