Provider Demographics
NPI:1871564815
Name:LONG, CARL EDWARD JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:EDWARD
Last Name:LONG
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2817 ROCKET MERRITT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2817 ROCKET MERRITT AVE
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-5005
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2025-01-30
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Provider Licenses
StateLicense IDTaxonomies
1053572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical