Provider Demographics
NPI:1639598089
Name:LUNG & SLEEP SPECIALIST, LLC
Entity Type:Organization
Organization Name:LUNG & SLEEP SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOORANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-277-4799
Mailing Address - Street 1:1210 BROADRICK DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2676
Mailing Address - Country:US
Mailing Address - Phone:706-277-4799
Mailing Address - Fax:706-277-5054
Practice Address - Street 1:1210 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2676
Practice Address - Country:US
Practice Address - Phone:706-277-4799
Practice Address - Fax:706-277-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042678261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA29BDCBJOtherMEDICARE PTAN
GA000744906CMedicaid
GAF95939Medicare UPIN