Provider Demographics
NPI:1407287493
Name:ANDERSON SLEEP AND LUNG CENTER PC
Entity Type:Organization
Organization Name:ANDERSON SLEEP AND LUNG CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOWDHAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-512-6459
Mailing Address - Street 1:1403 E GREENVILLE ST
Mailing Address - Street 2:STE C
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1403 E GREENVILLE ST
Practice Address - Street 2:STE C
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2049
Practice Address - Country:US
Practice Address - Phone:864-512-6459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17935207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty