Healthcare Provider Details

I. General information

NPI: 1659408730
Provider Name (Legal Business Name): WENDY J. LONG M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GREAT CIRCLE RD
NASHVILLE TN
37243-1700
US

IV. Provider business mailing address

2875 FAIRVIEW BLVD
FAIRVIEW TN
37062-8116
US

V. Phone/Fax

Practice location:
  • Phone: 615-507-6444
  • Fax:
Mailing address:
  • Phone: 615-799-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD18690
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: