Provider Demographics
NPI:1811591134
Name:LONG, KAREN MICHELE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELE
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 1:2825 BURNING BUSH RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-5750
Mailing Address - Country:US
Mailing Address - Phone:423-432-4811
Mailing Address - Fax:706-861-9630
Practice Address - Street 1:820 MISSION RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-4246
Practice Address - Country:US
Practice Address - Phone:706-866-6981
Practice Address - Fax:706-861-9630
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN73543336C0003X
GA0165683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy