Healthcare Provider Details

I. General information

NPI: 1346293628
Provider Name (Legal Business Name): JAY C LONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK DRIVE EAST SUITE 100
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

1 MEDICAL PARK DRIVE EAST SUITE 100
BIRMINGHAM AL
35235
US

V. Phone/Fax

Practice location:
  • Phone: 205-833-6907
  • Fax: 205-833-6987
Mailing address:
  • Phone: 205-833-6907
  • Fax: 205-833-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24476
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24476
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: