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The Longstreet Clinic, Pc

Internal Medicine

Allopathic & Osteopathic Physicians

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

PECOS Enrollment

Based on the most recent information from CMS, provider The Longstreet Clinic, Pc does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1326019977
Provider Type
Organization
Full Name
The Longstreet Clinic, Pc

Subpart
No
Enumeration Date
1/31/2006
Last Updated
5/27/2021

Contact Information

Practice Location

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

(770) 718-1122

(770) 533-4786

Mailing Location

PO Box 658, Gainesville, GA 30503-0658

(770) 718-1122

(770) 533-4786

Authorized Official

Collins, Amelia Lowe (Ceo)

(770) 718-1122

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer Georgia
Code 207RH0003X	Description Internal Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207V00000X	Description Obstetrics & Gynecology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207VG0400X	Description Obstetrics & Gynecology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207VM0101X	Description Obstetrics & Gynecology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207X00000X	Description Orthopaedic Surgery Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 207ZP0102X	Description Pathology Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208000000X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 2080N0001X	Description Pediatrics Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208100000X	Description Physical Medicine & Rehabilitation Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208600000X	Description Surgery Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208D00000X	Description General Practice Allopathic & Osteopathic Physicians	License Unlisted Issuer
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License Unlisted Issuer

The Longstreet Clinic, Pc

PECOS Enrollment

Profile Details

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