Provider Demographics
NPI:1821156688
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:THOPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-838-3000
Mailing Address - Street 1:8901 STONEBRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2210
Mailing Address - Country:US
Mailing Address - Phone:678-838-3000
Mailing Address - Fax:678-838-3155
Practice Address - Street 1:8901 STONEBRIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2210
Practice Address - Country:US
Practice Address - Phone:678-838-3000
Practice Address - Fax:678-838-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0604403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA29BDCLCMedicare ID - Type UnspecifiedDR.OSENI
11BDVHWMedicare ID - Type UnspecifiedANURADHA THOPU MD