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General NPI Number Information
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NPI Number | 1205233442
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Entity Type | Organization
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Legal Business Name | DR PAUL LONG, LLC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 89 MAIN ST
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City | HILTON HEAD
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State | SC
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Zip | 29926-6613
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Country | US
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Telephone | 843-681-5305
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Fax | 843-689-5210
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Provider Business Mailing Address
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Address Line | 89 MAIN ST
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City | HILTON HEAD
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State | SC
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Zip | 29926-6613
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Country | US
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Telephone | 843-681-5305
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Fax | 843-689-5210
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M LONG
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Credential | MD
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Telephone | 843-681-5305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 8178
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 8178
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License Number State | SC
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