Provider Demographics
NPI:1770634537
Name:PULMONARY DIAGNOSTIC TESTING LLC
Entity Type:Organization
Organization Name:PULMONARY DIAGNOSTIC TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, CPFT
Authorized Official - Phone:770-935-1672
Mailing Address - Street 1:3616 STEVE REYNOLDS BLVD
Mailing Address - Street 2:STE. 11
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5529
Mailing Address - Country:US
Mailing Address - Phone:770-935-1672
Mailing Address - Fax:770-935-1682
Practice Address - Street 1:3616 STEVE REYNOLDS BLVD
Practice Address - Street 2:STE. 11
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5529
Practice Address - Country:US
Practice Address - Phone:770-935-1672
Practice Address - Fax:770-935-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0023962251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5903870001Medicare NSC