Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 066714 | GA |
Y | 208600000X | Surgeon | 066714 | GA |
N | 2086S0102X | Surgical Critical Care | 066714 | GA |
NPI | 1205013851 |
---|---|
Provider Name | Eric L Long |
First Address | Macon, GA 31201-7528 |
Second Address | Macon, GA 31201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 23/09/2020 |