Individual
DIANE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6215 HUMPHREYS BLVD, SUITE 500, MEMPHIS, TN 38120-2367
(901) 682-0630
(901) 682-0635
Mailing address
6215 HUMPHREYS BLVD, SUITE 500, MEMPHIS, TN 38120-2367
(901) 682-0630
(901) 682-0635
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15391
TN
Other
Enumeration date
07/12/2006
Last updated
07/08/2007
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