Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC0000002223 | TN |
NPI | 1164499547 |
---|---|
Provider Name | Douglas L Long |
First Address | Nashville, TN 37205-2118 |
Second Address | Nashville, TN 37205-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 30/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1670129 | MEDICARE (01) | TN |
U51652 | (02) |