Provider Demographics
NPI:1407623424
Name:LONG, HAILEY (OD)
Entity type:Individual
Prefix:DR
First Name:HAILEY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FORRESTER DR SE
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-2006
Mailing Address - Country:US
Mailing Address - Phone:229-405-6249
Mailing Address - Fax:229-329-4373
Practice Address - Street 1:505 FORRESTER DR SE
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-2006
Practice Address - Country:US
Practice Address - Phone:229-405-6249
Practice Address - Fax:229-329-4373
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3033-IOD152W00000X
GAOPT003689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist