Individual
SARA-GRACE KATHERINE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 EXETER RD, GERMANTOWN, TN 38138-3966
(901) 701-5540
Mailing address
2078 STANDING ROCK AVE, COLLIERVILLE, TN 38017-7908
(901) 848-2202
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174671
BAPTIST
—
Enumeration date
02/24/2023
Last updated
02/24/2023
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