Healthcare Provider Details

I. General information

NPI: 1477566552
Provider Name (Legal Business Name): ADRIENNE SUSAN LONG M ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HOLSTON DR NOLA CHUCKEY
GREENEVILLE TN
37743-3127
US

IV. Provider business mailing address

PO BOX 9054
GRAY TN
37615-9054
US

V. Phone/Fax

Practice location:
  • Phone: 423-639-1100
  • Fax: 423-639-7045
Mailing address:
  • Phone: 423-467-3600
  • Fax: 423-467-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: