Organization
THE LONGSTREET CLINIC PC
Active
Parent organization
THE LONGSTREET CLINIC, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE LONGSTREET CLINIC, PC
Authorized official
AMELIA LOWE COLLINS (CEO)
(770) 718-1122
Entity
Organization
Contact information
Practice address
725 JESSE JEWELL PKWY SE STE 395, GAINESVILLE, GA 30501-3834
(770) 533-6680
(770) 533-6681
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 535-7445
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
439568713A
—
GA
Enumeration date
08/31/2006
Last updated
08/06/2025
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