Provider Demographics
NPI:1659327344
Name:LONG, WILLIAM SHERMAN JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SHERMAN
Last Name:LONG
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0446
Mailing Address - Country:US
Mailing Address - Phone:423-280-5215
Mailing Address - Fax:843-842-5215
Practice Address - Street 1:7900 RHEA MEDICAL CENTER
Practice Address - Street 2:RHEA COUNTY HWY
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321
Practice Address - Country:US
Practice Address - Phone:423-775-1121
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN142793OtherBLUE CROSS BS
3600263Medicare ID - Type Unspecified