=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780745646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGIANNA LEE PRINCE-LONG AU.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15700 STATE ROUTE 170 STE A
-----------------------------------------------------
City | EAST LIVERPOOL
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43920-9657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-368-0166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17420 CANNONS MILLS ROAD
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-913-5475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AT005954
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | A01439
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | A.01439
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------