Healthcare Provider Details

I. General information

NPI: 1598712713
Provider Name (Legal Business Name): DEBORAH SCHULTE LONG CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 MCCLURE BRIDGE RD
DULUTH GA
30096-3131
US

IV. Provider business mailing address

3500 MCCLURE BRIDGE RD
DULUTH GA
30096-3131
US

V. Phone/Fax

Practice location:
  • Phone: 770-476-3636
  • Fax: 770-476-5845
Mailing address:
  • Phone: 770-476-3636
  • Fax: 770-476-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN075203
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN075203
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: