MEDICARE: DR. JAMES MICHAEL LONG DMD

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	122300000X	Dentist	011375	GA

General Provider Information

NPI Number	:	1700878170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MICHAEL LONG DMD

Provider Business Mailing Address
First Line	:	2518 LOGANVILLE HWY
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017
Country	:	US
Telephone Number	:	770-237-2220
Fax Number	:	770-237-2955

Provider Business Practice Location Address
First Line	:	2518 LOGANVILLE HWY
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017
Country	:	US
Telephone Number	:	770-237-2220
Fax Number	:	770-237-2955

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/29/2013

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