Provider Demographics
NPI:1598795957
Name:LONG, JAMES N JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:LONG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ALCORN DRIVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834
Mailing Address - Country:US
Mailing Address - Phone:205-532-0316
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DR STE 100
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9322
Practice Address - Country:US
Practice Address - Phone:205-532-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23375208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05283311Medicaid
410872ZH3EMedicare Oscar/Certification
AL000007531OtherBLUE CROSS
AL051552210Medicare ID - Type Unspecified
AL051519087OtherBLUE CROSS
AL051552210Medicaid
AL009932621Medicaid
ALA29419OtherHEALTHSPRING OF ALABAMA
AL051511233OtherBLUE CROSS
AL000007531Medicaid
AL051529618OtherBLUE CROSS
AL051527610OtherBLUE CROSS