| Doctor Name: | DR. KATHLEEN A LONG |
| NPI Number: | 1043215403 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 038549 |
| Business Practice Address: | 144 Bill Carruth Pkwy Suite 3100 Hiram, GA - 301413749 |
| Business Phone Number: | 6783631940 |
| Business Fax Number: | 6785817110 |
| Mailing Address: | 531 Roselane St Nw, Suite 710 MARIETTA |
| State: | GA |
| Postal Code: | 300606913 |
| Phone Number: | 6783313302 |
| Fax Number: | 6785817187 |
| NPI Enumeration Date: | 06/14/2005 |
| NPI Last Update Date: | 07/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 038549 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |