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DR. ELIZABETH BROMAN LONG MD

>> Pediatrics >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1780900274

Individual Registrant:
DR. ELIZABETH BROMAN LONG MD
Gender: F
Sole Proprietor

Location and contact information for practice:
11 CHARLIE MORRIS RD  COLBERT, GA 30628-2445 US
Tel: 706-788-2127  Fax: 706-788-2815

Contact information for business:
PO BOX 459  COLBERT, GA 30628-0459 US
Tel: 706-788-3234  Fax: 706-788-2936

Registration Information:
NPI: 1780900274
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y208000000XAllopathic & Osteopathic Physicians
Pediatrics
GA069308

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
003134590AGA05




HEALTH CARE JOBS GA - Page 1



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