Provider Demographics
NPI:1528695780
Name:LONG, JODI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 CUMBERLAND PKWY SE STE 305
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6360
Mailing Address - Country:US
Mailing Address - Phone:404-785-4271
Mailing Address - Fax:
Practice Address - Street 1:1675 CUMBERLAND PKWY SE STE 305
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6360
Practice Address - Country:US
Practice Address - Phone:404-785-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0115772251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports