Provider Demographics
NPI:1760446181
Name:LONG, BRIAN D (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3225 CUMBERLAND BLVD SE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6407
Mailing Address - Country:US
Mailing Address - Phone:404-351-2220
Mailing Address - Fax:404-355-5624
Practice Address - Street 1:340 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1562
Practice Address - Country:US
Practice Address - Phone:770-719-7950
Practice Address - Fax:770-460-1739
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-03-19
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Provider Licenses
StateLicense IDTaxonomies
GA043413207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDFDROtherMEDICARE ID
GA000755521AMedicaid
GA18BDFDROtherMEDICARE ID
GA000755521AMedicaid
GA00965Medicare PIN