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General NPI Number Information
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NPI Number | 1548788482
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Entity Type | Individual
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Provider Name | SALLIE MARTIN LONG
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Gender | Female
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Dates
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Enumeration Date | 08/30/2017
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-1002
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Country | US
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Telephone | 706-721-8623
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Fax | 706-721-1459
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Provider Business Mailing Address
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Address Line | 1120 15TH ST # OR6000
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-3813
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME159941
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 98473
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License Number State | GA
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