Individual
MR. OLIN IMAN LONGINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3510 HIGHWAY 17 BYP N STE 215, MT PLEASANT, SC 29466-8229
(843) 402-1766
(843) 402-1768
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3139
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3136PA
—
SC
Enumeration date
12/06/2018
Last updated
05/01/2025
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