Provider Demographics
NPI:1225030182
Name:LONG, BYRON A (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:A
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:895 CANTON RD NE
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8934
Mailing Address - Country:US
Mailing Address - Phone:770-427-8111
Mailing Address - Fax:770-499-1643
Practice Address - Street 1:895 CANTON RD NE
Practice Address - Street 2:BUILDING 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8934
Practice Address - Country:US
Practice Address - Phone:770-427-8111
Practice Address - Fax:770-499-1643
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA050037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDFWLMedicare ID - Type Unspecified
G96833Medicare UPIN