Provider Demographics
NPI:1598051054
Name:THE LUNG CENTERS OF GEORGIA
Entity Type:Organization
Organization Name:THE LUNG CENTERS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-838-3000
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30133-1076
Mailing Address - Country:US
Mailing Address - Phone:678-838-3000
Mailing Address - Fax:678-838-3155
Practice Address - Street 1:340 BOULEVARD NE
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1273
Practice Address - Country:US
Practice Address - Phone:404-600-3300
Practice Address - Fax:404-748-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000790908EMedicaid
GA000790908EMedicaid