Individual
RUSSELL E LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1114 W MADISON AVE, ATHENS, TN 37303-4150
(423) 745-1411
Mailing address
PO BOX 220, ATHENS, TN 37371-0220
(423) 424-3695
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA#10632
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3629553
—
TN
01
—
4129533
BLUE CROSS BLUE SHIELD
TN
01
—
P00343315
RR MEDICARE
TN
Enumeration date
12/30/2005
Last updated
10/26/2007
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