Provider Demographics
NPI:1962645259
Name:LONG, TAURA L (MD)
Entity Type:Individual
Prefix:
First Name:TAURA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-889-1591
Mailing Address - Fax:615-889-0599
Practice Address - Street 1:4777 ANDREW JACKSON PKWY
Practice Address - Street 2:102
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1323
Practice Address - Country:US
Practice Address - Phone:615-889-1591
Practice Address - Fax:615-889-0599
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000047878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6056729OtherBCBST
TNP01601955OtherRR MEDICARE
TN1529002Medicaid
TN1529002Medicaid
TN103I081054Medicare PIN