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Organization

THE LONGSTREET CLINIC, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AMELIA LOWE COLLINS (CEO)
(770) 718-1122
Entity
Organization

Contact information

Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(770) 718-1122
(770) 533-4786
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
GA
207R00000X
Internal Medicine Physician
Primary
207RH0003X
Hematology & Oncology Physician
207V00000X
Obstetrics & Gynecology Physician
207VG0400X
Gynecology Physician
207VM0101X
Maternal & Fetal Medicine Physician
207X00000X
Orthopaedic Surgery Physician
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
208000000X
Pediatrics Physician
2080N0001X
Neonatal-Perinatal Medicine Physician
208100000X
Physical Medicine & Rehabilitation Physician
208600000X
Surgery Physician
208D00000X
General Practice Physician
208M00000X
Hospitalist Physician

Other

Enumeration date
01/31/2006
Last updated
05/27/2021
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