Healthcare Provider Details

I. General information

NPI: 1790744241
Provider Name (Legal Business Name): W. LAWRENCE LONG, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR CALDWELL COUNTY HOSPITAL
PRINCETON KY
42445-0410
US

IV. Provider business mailing address

PO BOX 42
HOPKINSVILLE KY
42241-0042
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-0442
  • Fax: 270-365-0316
Mailing address:
  • Phone: 270-886-4556
  • Fax: 270-707-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18271
License Number StateKY

VIII. Authorized Official

Name: DR. WILLIAM LAWRENCE LONG
Title or Position: PRESIDENT
Credential: MD
Phone: 270-885-1244