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General NPI Number Information
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NPI Number | 1477147031
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Entity Type | Individual
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Provider Name | MELISSA ANN LONG
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Gender | Female
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 2000 RIVERSIDE PKWY STE 207
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5926
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Country | US
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Telephone | 678-646-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 1493 LECHEMIN DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-6791
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Country | US
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Telephone | 470-273-1699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN226768
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License Number State | GA
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