Provider Demographics
NPI:1659408730
Name:LONG, WENDY J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:J
Last Name:LONG
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2875 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-8116
Mailing Address - Country:US
Mailing Address - Phone:615-799-0959
Mailing Address - Fax:
Practice Address - Street 1:310 GREAT CIRCLE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37243-1700
Practice Address - Country:US
Practice Address - Phone:615-507-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD186902083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD18690OtherMEDICAL LICENSE