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General NPI Number Information
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NPI Number | 1518870849
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Entity Type | Organization
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Legal Business Name | MD SEA TO SEA PC
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Dates
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Enumeration Date | 09/26/2026
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Last Update Date | 09/26/2026
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Provider Practice Location Address
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Address Line | 2055 N MOUNT JULIET RD STE 100
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City | MT JULIET
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State | TN
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Zip | 37122-4287
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Country | US
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Telephone | 760-809-4267
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Fax | 858-500-1812
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Provider Business Mailing Address
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Address Line | 819 N BRAGG AVE
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City | LOOKOUT MOUNTAIN
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State | TN
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Zip | 37350-1003
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Country | US
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Telephone | 760-809-4267
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Fax | 858-500-1812
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN LONG
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Credential | MD, MPH
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Telephone | 760-809-4267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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