Provider Demographics
NPI:1881632040
Name:LONG, SAMMIE I (MD)
Entity Type:Individual
Prefix:MRS
First Name:SAMMIE
Middle Name:I
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1817 SPRING BROOK CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2587
Mailing Address - Country:US
Mailing Address - Phone:251-666-5939
Mailing Address - Fax:615-837-6449
Practice Address - Street 1:1817 SPRING BROOK CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2587
Practice Address - Country:US
Practice Address - Phone:251-666-5939
Practice Address - Fax:615-837-6449
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL16-10378OtherUNITED HEALTHCARE
AL51003709OtherBCBS
AL51533359OtherBCBS
MS00119516Medicaid
AL16-10378OtherUNITED HEALTHCARE
E88730Medicare UPIN