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The Longstreet Clinic Pc
Prosthetic/Orthotic Supplier in Gainesville, Georgia
NPI 1053422428

The Longstreet Clinic Pc is a Prosthetic/Orthotic Supplier based in Gainesville, GA. The Longstreet Clinic Pc practices in Gainesville, GA. The NPI Number for The Longstreet Clinic Pc is 1053422428 and holds a License No. (Georgia).

The current practice location address for The Longstreet Clinic Pc is 725 Jesse Jewell Pkwy Se Ste 395, Gainesville, GA and can be reached out via phone at 770-533-6680 and via fax at 770-533-6681.

Location: 725 Jesse Jewell Pkwy Se Ste 395, Gainesville, GA, 30503-0658
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1053422428
Provider Name
The Longstreet Clinic Pc
Credential
Provider Entity Type
Organization
Address
725 Jesse Jewell Pkwy Se Ste 395, Gainesville, GA, 30503-0658
Phone Number
770-533-6680
Fax Number
770-533-6681
Provider Enumeration Date
08/31/2006
Last Update Date
05/18/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1154222 01 NCPDP PROVIDER IDENTIFICATION NUMBER
439568713B 05 GA
439568713A 05 GA
institution
Provider Business Practice Location Address Details
Address
725 Jesse Jewell Pkwy Se Ste 395
City
Gainesville
State
Georgia
Zip
30501-3834
Phone Number
770-533-6680
Fax Number
770-533-6681
person
Provider Business Mailing Address Details
Address
725 Jesse Jewell Pkwy Se Ste 395
City
Gainesville
State
Georgia
Zip
30501-3834
Phone Number
770-533-6680
Fax Number
770-533-6681
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Pharmacy
Speciality
-
Taxonomy
333600000X
License No.
()
Definition
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.
person
Provider's Taxonomy Details 2
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
()
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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