Longevity Clinical LTC Associates of Georgia, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LONGEVITY CLINICAL LTC ASSOCIATES OF GEORGIA, PC

Practice address

1040 Crown Pointe Pkwy Ste 600
Atlanta, GA 30338-4741

Phone

(561) 815-2427

NPI assigned

Jun 5, 2023

Last updated

Jun 5, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diane L Vincur

Title

LWC Practice Manager

Phone

(561) 815-2427

Specialties & licenses 4

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Waseem Ghannam

  • Family Medicine Physician
  • Pineville, NC
  • NPI 1306080510
  NPD
• Eileen O'Hara

  • Gerontology Nurse Practitioner
  • New York, NY
  • NPI 1831240712
  NPD
• Robin Diane Stone, RN, FNP-C

  • Family Nurse Practitioner
  • Cleveland, OH
  • NPI 1598912206
  NPD

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

{
    "created_epoch": "1685923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1699469668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11780 US HIGHWAY 1 STE N107",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334083007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 CROWN POINTE PKWY STE 600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303384741",
            "telephone_number": "561-815-2427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CLINICAL LTC ASSOCIATES OF GEORGIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "VINCUR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "LWC PRACTICE MANAGER",
        "authorized_official_telephone_number": "561-815-2427"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Louise Long, LPC
• Robert Anthony Long, DMD
• Sarah Jane Long
• Long's Drugs of Sandersville, Georgia, Inc. (AvitaCare)
• Long's Drugs of Sandersville, Georgia, Inc. (Avita Pharmacy 1046)
• Longevity Medical Center, PC
• Longleaf Hospice, LLC
• Jean V Longley, MD
• Longs Drugs of Sandersville Georgia Inc (Avita Pharmacy 1046)
• Sagar Lonial, M.D.

• Family Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2023; 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.