Individual
DR. KELLY ANN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 408-3277
(803) 408-3299
Mailing address
15 EXCHANGE DR, LUGOFF, SC 29078-9198
(803) 408-3277
(803) 408-3299
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2008
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0255
—
SC
Enumeration date
11/01/2006
Last updated
05/26/2020
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