Individual
MR. CHARLES WILBURN LONG III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
2501 INTERNATIONAL PARK DR, BIRMINGHAM, AL 35243-4253
(205) 813-7400
Mailing address
2501 INTERNATIONAL PARK DR, BIRMINGHAM, AL 35243-4253
(205) 813-7400
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-141931
AL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1-141931
AL
Other
Enumeration date
02/07/2021
Last updated
09/27/2022
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