Provider Demographics
NPI:1598076275
Name:LONG H. LE, M.D.,P.C.
Entity Type:Organization
Organization Name:LONG H. LE, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-777-9845
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:BLDG. 200 SUITE 201
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4248
Mailing Address - Country:US
Mailing Address - Phone:770-777-9845
Mailing Address - Fax:770-777-9846
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:BLDG. 200 SUITE 201
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4248
Practice Address - Country:US
Practice Address - Phone:770-777-9845
Practice Address - Fax:770-777-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60349Medicare UPIN