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General NPI Number Information
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NPI Number | 1962482992
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Entity Type | Individual
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Provider Name | GEORGANNE LONG M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 1401 JOHNSTON WILLIS DR SUITE 5000
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City | RICHMOND
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State | VA
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Zip | 23235-4730
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Country | US
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Telephone | 804-320-2483
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Fax | 804-794-0050
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Provider Business Mailing Address
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Address Line | 1 PARKWEST CIR SUITE 202
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-5551
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Country | US
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Telephone | 804-320-2483
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Fax | 804-794-0050
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 0101042241
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License Number State | VA
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