MEDICARE: DR. SARA LONG M.D.

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
1	208600000X	Surgery Physician	MD41574	TN

General Provider Information

NPI Number	:	1629158233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA LONG M.D.

Provider Business Mailing Address
First Line	:	322 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3963
Country	:	US
Telephone Number	:	615-384-2714
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3963
Country	:	US
Telephone Number	:	615-384-2714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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