Healthcare Provider Details

I. General information

NPI: 1346392339
Provider Name (Legal Business Name): LUNG CARE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W SUITE 500D
FAYETTEVILLE GA
30214-4548
US

IV. Provider business mailing address

PO BOX 2231
PEACHTREE CITY GA
30269-0231
US

V. Phone/Fax

Practice location:
  • Phone: 678-613-5554
  • Fax: 678-817-7125
Mailing address:
  • Phone: 678-613-5554
  • Fax: 678-817-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number056185
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number056185
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number056185
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number056185
License Number StateGA

VIII. Authorized Official

Name: OLUMUYIWA JOSHUA
Title or Position: PHYSICIAN
Credential: MD FCCP
Phone: 678-613-5554