Healthcare Provider Details

I. General information

NPI: 1437924586
Provider Name (Legal Business Name): GEORGE NELSON LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 11/20/2023
Certification Date: 11/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

4536 HAVERTY DR
KNOXVILLE TN
37931-3657
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9112
  • Fax:
Mailing address:
  • Phone: 865-363-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0000083817
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: