Provider Demographics
NPI:1679871099
Name:WALTON PULMONARY & SLEEP MEDICINE PC
Entity Type:Organization
Organization Name:WALTON PULMONARY & SLEEP MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANNOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-928-9700
Mailing Address - Street 1:101 TARA COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8018
Mailing Address - Country:US
Mailing Address - Phone:678-928-9700
Mailing Address - Fax:770-466-1585
Practice Address - Street 1:101 TARA COMMONS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8018
Practice Address - Country:US
Practice Address - Phone:678-928-9700
Practice Address - Fax:770-466-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065686207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty