=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407354277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANNAH LONG PRICE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2018
-----------------------------------------------------
Last Update Date | 05/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 S MAIN ST
-----------------------------------------------------
City | PETAL
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39465-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-336-5626
-----------------------------------------------------
Fax | 601-336-7826
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 206 E MAIN ST
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39056-4262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-231-2293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | PA00363
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA00363
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------