Individual
BRIAN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
51 E PAULDING DR, DALLAS, GA 30157-7190
(770) 505-8988
Mailing address
51 E PAULDING DR, DALLAS, GA 30157-7190
(770) 505-8988
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
018378
GA
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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