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NPI Code Detail

MEDICARE: JEAN V LONGLEY MD

MEDICARE:   JEAN V LONGLEY  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology Physician30640GA

General Provider Information

NPI Number : 1528276904
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN V LONGLEY MD
Provider Business Mailing Address
First Line : 6195 HEARDS CREEK DR NW
Second Line :
City : ATLANTA
State : GA
Zip : 30328-3653
Country : US
Telephone Number : 404-843-3913
Fax Number :
Provider Business Practice Location Address
First Line : 6195 HEARDS CREEK DR NW
Second Line :
City : ATLANTA
State : GA
Zip : 30328-3653
Country : US
Telephone Number : 404-843-3913
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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Directions to “ JEAN V LONGLEY MD” Practice Location

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