Individual
JASON ANDREW LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-3076
(864) 455-4135
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8614
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024175682
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
24282
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN3341
—
SC
Enumeration date
02/03/2012
Last updated
12/27/2021
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