The Longstreet Clinic Pc

LBN: The Longstreet Clinic Pc
The Longstreet Clinic Pc is an health care organization with primary practice located at 725 Jesse Jewell Pkwy Se Ste 395 , Gainesville GA 30501-3834. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Prosthetic/Orthotic Supplier. Suppliers / Prosthetic/Orthotic Supplier is the primary health care specialty. The Longstreet Clinic Pc can be contacted via phone (770) 533-6680, or through Collins, Amelia Lowe via phone (770) 718-1122.

Contact Information

Primary practice address
725 Jesse Jewell Pkwy Se Ste 395 Gainesville GA 30501-3834
Fax: (770) 533-6681
Website:
Authorized official contact:
Name: Collins, Amelia Lowe

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Prosthetic/Orthotic Supplier 335E00000X

Profile Details

NPI number 1053422428
LBN Legal business name The Longstreet Clinic Pc
DBA Doing business as
Authorized official Collins, Amelia Lowe
Entity Organization
Organization subpart 1 Yes
Enumeration date Aug 31st, 2006
Last updated Apr 11th, 2024 - about 5 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053422428 NPPES
Other 1154222 NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID 439568713B NCPDP PROVIDER IDENTIFICATION NUMBER
MEDICAID 439568713A NCPDP PROVIDER IDENTIFICATION NUMBER

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