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General NPI Number Information
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NPI Number | 1801703483
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Entity Type | Individual
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Provider Name | JOHN LONG
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Gender | Male
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 7008 PEMMBROOKE SHIRE LN
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City | KNOXVILLE
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State | TN
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Zip | 37909-1274
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Country | US
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Telephone | 865-399-1967
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Fax |
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Provider Business Mailing Address
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Address Line | 7008 PEMMBROOKE SHIRE LN
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City | KNOXVILLE
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State | TN
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Zip | 37909-1274
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Country | US
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Telephone | 865-399-1967
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 0940-05-38
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License Number State | TN
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