Individual
JACOB LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7895
Mailing address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7895
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
LL89833
SC
Other
Enumeration date
07/04/2021
Last updated
06/28/2023
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