Provider Demographics
NPI:1962645259
Name:LONG, TAURA L (MD)
Entity type:Individual
Prefix:
First Name:TAURA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:4777 ANDREW JACKSON PKWY
Practice Address - Street 2:102
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1323
Practice Address - Country:US
Practice Address - Phone:615-889-1591
Practice Address - Fax:615-889-0599
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000047878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01601955OtherRR MEDICARE
TN6056729OtherBCBST
TN1529002Medicaid
TN1529002Medicaid
TN103I081054Medicare PIN