Basic Information
| Provider Information | |||||||||
| NPI: | 1114130408 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 AIRPARK CENTER DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372175200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152214400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3512 OLD MONTGOMERY HWY | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352095706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058792260 | ||||||||
| FaxNumber: | 2058792261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | MD.25042 | AL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZD0900X | MD.25042 | AL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology |
ID Information
| ID | Type | State | Issuer | Description | 1114130408 | 05 | AL | MEDICAID |