Individual
BRIAN D LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1562
(770) 719-7950
(770) 460-1739
Mailing address
3225 CUMBERLAND BLVD SE, SUITE 900, ATLANTA, GA 30339-6407
(404) 351-2220
(404) 355-5624
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
043413
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000755521A
—
GA
01
—
18BDFDR
MEDICARE ID
GA
Enumeration date
04/13/2006
Last updated
03/19/2019
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