Individual
MR. JEFFREY NEIL LONGENECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1114 W MADISON AVE, ATHENS, TN 37303-4150
(423) 744-3308
(423) 744-3495
Mailing address
5016 LEWIS RD, MC DONALD, TN 37353-4069
(615) 829-3949
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1655
TN
363AM0700X
Medical Physician Assistant
1655
TN
363AS0400X
Surgical Physician Assistant
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3665294
—
TN
01
—
4204066
BSBS
TN
01
—
4204068
BCBS
TN
Enumeration date
09/08/2008
Last updated
03/17/2018
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