Organization
MIDLANDS ANESTHESIOLOGISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE S LONG MD (AUTHORIZED OFFICIAL)
(803) 254-2394
Entity
Organization
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 254-2394
Mailing address
PO BOX 16656, ATLANTA, GA 30321-0656
(803) 765-1838
(803) 765-1732
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
Other
Enumeration date
07/18/2018
Last updated
07/18/2018
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