The Longstreet Clinic, PC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

069-004 Issued in GA

Legal business name

THE LONGSTREET CLINIC, PC

Doing business as

The Longstreet Clinic Dept of Pathology/Interlab

Practice address

725 Jesse Jewell Pkwy SE
Suite 260
Gainesville, GA 30501-3834

Phone

(770) 535-0079

Fax

(770) 297-6610

NPI assigned

Jan 7, 2009

Organization subpart

Yes

Parent organization

THE LONGSTREET CLINIC, PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amelia L. Collins

Title

Ceo

Phone

(770) 718-1122

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Longstreet Clinic Dept of Pathology/Interlab Doing business as

Part of

Lonstreet Clinic PC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• The Longstreet Clinic, PC

  • Internal Medicine Physician
  • Gainesville, GA
  • NPI 1326019977
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1003052416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-718-1122",
            "fax_number": "770-535-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 JESSE JEWELL PKWY SE",
            "address_2": "SUITE 260",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013834",
            "telephone_number": "770-535-0079",
            "fax_number": "770-297-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LONGSTREET CLINIC, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE LONGSTREET CLINIC, PC",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-718-1122"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "GA",
            "license": "069-004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000679764A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Longstreet Clinic Dept of Pathology/Interlab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.