Provider Demographics
NPI:1275143380
Name:LONG, STEPHANIE DIANE-HUNSLEY (RPH)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE-HUNSLEY
Last Name:LONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:HUNSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 ANNANDALE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5757
Mailing Address - Country:US
Mailing Address - Phone:770-354-4253
Mailing Address - Fax:
Practice Address - Street 1:1050 E PIEDMONT RD STE P
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4744
Practice Address - Country:US
Practice Address - Phone:770-509-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist