Provider Demographics
NPI:1841324639
Name:ATLANTIC LUNG CENTER INC
Entity type:Organization
Organization Name:ATLANTIC LUNG CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS AMANGER
Authorized Official - Prefix:
Authorized Official - First Name:IYABO
Authorized Official - Middle Name:F
Authorized Official - Last Name:MURAINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-744-9603
Mailing Address - Street 1:PO BOX 24299
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31212-4299
Mailing Address - Country:US
Mailing Address - Phone:478-744-9603
Mailing Address - Fax:478-744-9552
Practice Address - Street 1:560 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2824
Practice Address - Country:US
Practice Address - Phone:478-744-9603
Practice Address - Fax:478-744-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044029261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDMVHMedicare ID - Type Unspecified
GAG54538Medicare UPIN