Organization
THE LONGSTREET CLINIC, PC
Active
Parent organization
THE LONGSTREET CLINIC, PC
Other names
The Longstreet Clinic Dept of Pathology/Interlab
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE LONGSTREET CLINIC, PC
Authorized official
AMELIA L. COLLINS (CEO)
(770) 718-1122
Entity
Organization
Contact information
Practice address
725 JESSE JEWELL PKWY SE, SUITE 260, GAINESVILLE, GA 30501-3834
(770) 535-0079
(770) 297-6610
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
069-004
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000679764A
—
GA
Enumeration date
01/07/2009
Last updated
01/07/2009
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