Elizabeth Broman Long, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

069308 Issued in GA

Practice address

11 Charlie Morris Rd
Colbert, GA 30628-2445

Phone

(706) 788-2127

Fax

(706) 788-2815

NPI assigned

Apr 9, 2010

Last updated

Aug 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: elizabeth.long.1@18823.direct.athenahealth.com

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

{
    "created_epoch": "1270771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470441600000",
    "number": "1780900274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306280459",
            "telephone_number": "706-788-3234",
            "fax_number": "706-788-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CHARLIE MORRIS RD",
            "city": "COLBERT",
            "state": "GA",
            "postal_code": "306282445",
            "telephone_number": "706-788-2127",
            "fax_number": "706-788-2815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "ELIZABETH",
        "middle_name": "BROMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-09",
        "last_updated": "2016-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "069308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003134590A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jordan Hoffman, LCSW
• Alicia M Hopkins, D.O.
• Innovative Medical Group (Innovative Medical)
• Jaime Tara Johnson-Huff, RN
• John S. Kahle
• Med South EMS Inc
• Medlink Georgia Inc (Medlink Pharmacy- Colbert)
• Medlink Georgia Inc
• Medlink Georgia Inc
• Medlink Georgia Inc (Medlink Colbert Building 2)

• Pediatrics Physician in Colbert, GA
• Providers in Colbert, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2016; 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.