Provider Demographics
NPI:1710211891
Name:LONG, STEPHEN M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:LONG
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1025 EXECUTIVE DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7916
Mailing Address - Country:US
Mailing Address - Phone:423-870-2030
Mailing Address - Fax:423-877-5363
Practice Address - Street 1:1025 EXECUTIVE DR
Practice Address - Street 2:SUITE #100
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7916
Practice Address - Country:US
Practice Address - Phone:423-870-2030
Practice Address - Fax:423-877-5363
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2014-03-31
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Provider Licenses
StateLicense IDTaxonomies
TN1753363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant