Individual
JALETTA L LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN MN CFNP
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-3356
Mailing address
PO BOX 4019, ATLANTA, GA 30302-4019
(404) 413-1191
(404) 413-1191
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
RN060596
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000864366A
—
GA
Enumeration date
11/27/2006
Last updated
03/26/2015
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