Provider Demographics
NPI:1518120187
Name:LONG, ASHLEY H (PA-C)
Entity Type:Individual
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First Name:ASHLEY
Middle Name:H
Last Name:LONG
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2025 FRONTIS PLAZA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5663
Mailing Address - Country:US
Mailing Address - Phone:336-768-6211
Mailing Address - Fax:336-768-6869
Practice Address - Street 1:2025 FRONTIS PLAZA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5663
Practice Address - Country:US
Practice Address - Phone:336-768-6211
Practice Address - Fax:336-768-6869
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2011-09-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-01417OtherNC MEDICAL LICENSE