Healthcare Provider Details

I. General information

NPI: 1568038859
Provider Name (Legal Business Name): JOSHUA VANLONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6053 JONESBORO RD
MORROW GA
30260-1106
US

IV. Provider business mailing address

6053 JONESBORO RD
MORROW GA
30260-1106
US

V. Phone/Fax

Practice location:
  • Phone: 770-824-4343
  • Fax:
Mailing address:
  • Phone: 770-824-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP214544
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: