Provider Demographics
NPI:1689356263
Name:LONG, KRISTAL L
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 AIRPORT RD # 1503
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4956
Mailing Address - Country:US
Mailing Address - Phone:224-587-0663
Mailing Address - Fax:
Practice Address - Street 1:1954 AIRPORT RD # 1503
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4956
Practice Address - Country:US
Practice Address - Phone:224-587-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide