Provider Demographics
NPI:1437117900
Name:LONG, JOHN G (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:993 F JOHNSON FERRY RD
Mailing Address - Street 2:STE 370
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-4611
Mailing Address - Fax:404-256-1756
Practice Address - Street 1:993 F JOHNSON FERRY RD
Practice Address - Street 2:STE 370
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-4611
Practice Address - Fax:404-256-1756
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025214208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA37BBDZLMedicare ID - Type Unspecified
G63631Medicare UPIN