# LONGEVITY MEDICAL CENTER, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124596069
- **Authorized official:** SAIRA SULTAN (DOO)
- **Authorized official phone:** (770) 676-6000

## Contact information

- **Practice address:** 4646 N SHALLOWFORD RD STE 300, ATLANTA, GA 30338-6308
- **Practice address phone:** (678) 736-6383
- **Practice address fax:** (678) 280-6761
- **Mailing address:** 1551 DUNWOODY VILLAGE PKWY UNIT 888426, ATLANTA, GA 30356-0115
- **Mailing address phone:** (678) 736-6383
- **Mailing address fax:** (678) 280-6761

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2018
- **Last updated:** 11/08/2018