Healthcare Provider Details

I. General information

NPI: 1982508594
Provider Name (Legal Business Name): JARRED LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CALUMET CENTER RD
LAGRANGE GA
30241-6705
US

IV. Provider business mailing address

171 LEE ROAD 155
OPELIKA AL
36804-9372
US

V. Phone/Fax

Practice location:
  • Phone: 706-884-3274
  • Fax:
Mailing address:
  • Phone: 334-703-8856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: