Provider Demographics
NPI:1619029147
Name:LONG, ANGELA C (RD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:LONG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:C
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:506 ARROWHEAD VILLAGE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-5508
Mailing Address - Country:US
Mailing Address - Phone:205-495-5738
Mailing Address - Fax:205-487-7989
Practice Address - Street 1:1530 US HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5056
Practice Address - Country:US
Practice Address - Phone:205-487-7000
Practice Address - Fax:205-487-7666
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered