Provider Demographics
NPI:1023348398
Name:GADSDEN LUNG CENTER, P.C. INC
Entity type:Organization
Organization Name:GADSDEN LUNG CENTER, P.C. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-543-3877
Mailing Address - Street 1:PO BOX 1859
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35902-1859
Mailing Address - Country:US
Mailing Address - Phone:256-543-3877
Mailing Address - Fax:256-543-1539
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-543-3877
Practice Address - Fax:256-543-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17934207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
102G702227Medicare UPIN