| Doctor Name: | ERICA LONG |
| NPI Number: | 1225058464 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A. |
| License Number: | PA694 |
| Business Practice Address: | 3500 N Mount Juliet Rd Suite 201 Mt Juliet, TN - 371223078 |
| Business Phone Number: | 6157585672 |
| Business Fax Number: | 6157585609 |
| Mailing Address: | 3500 N Mount Juliet Rd, Suite 201 MT JULIET |
| State: | TN |
| Postal Code: | 371223078 |
| Phone Number: | 6157585672 |
| Fax Number: | 6157585609 |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA694 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |