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NPI Code Detail

MEDICARE: DR. JAMES LONG PH.D.

MEDICARE: DR. JAMES LONG PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist05-18PAR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15Y410OTHERARLOCAL BCBS
21932174836OTHERARCLINIC NPI#

General Provider Information

NPI Number : 1275526733
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES LONG PH.D.
Provider Business Mailing Address
First Line : PO BOX 2429
Second Line :
City : SMYRNA
State : TN
Zip : 37167-1719
Country : US
Telephone Number : 615-355-3451
Fax Number :
Provider Business Practice Location Address
First Line : 1100 N COLLEGE AVE
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-1944
Country : US
Telephone Number : 615-355-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 09/20/2018

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