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Individual

THAD D LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1601 FAIR RD, SUITE 1100, STATESBORO, GA 30458-1698
(678) 469-0007
(321) 206-0834
Mailing address
1601 FAIR RD, SUITE 1100, STATESBORO, GA 30458-1698
(678) 469-0007
(321) 206-0834

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
020769
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00237157H
GA
Enumeration date
08/11/2005
Last updated
08/20/2012
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