Healthcare Provider Details

I. General information

NPI: 1326237686
Provider Name (Legal Business Name): PHILLIP LONG DANG D.C.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4186 BUFORD HWY NE STE F
ATLANTA GA
30345-1067
US

IV. Provider business mailing address

4186 BUFORD HWY NE STE F
ATLANTA GA
30345-1067
US

V. Phone/Fax

Practice location:
  • Phone: 404-638-6060
  • Fax:
Mailing address:
  • Phone: 404-638-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberGA005961
License Number StateGA

VIII. Authorized Official

Name: DR. LONG P DANG
Title or Position: PRESIDENT
Credential: D.C.
Phone: 404-638-6060