Individual
SALLIE MARTIN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-1002
(706) 721-8623
(706) 721-1459
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
ME159941
FL
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
98473
GA
Other
Enumeration date
08/30/2017
Last updated
08/08/2024
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