Healthcare Provider Details

I. General information

NPI: 1285905653
Provider Name (Legal Business Name): PULMONARY ASSOCIATES OF GAINESVILLE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 WHITE SULPHUR RD SUITE 175
GAINESVILLE GA
30501-8921
US

IV. Provider business mailing address

675 WHITE SULPHUR RD SUITE 175
GAINESVILLE GA
30501-8921
US

V. Phone/Fax

Practice location:
  • Phone: 770-287-0110
  • Fax: 770-287-0904
Mailing address:
  • Phone: 770-287-0110
  • Fax: 770-287-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35587
License Number StateGA

VIII. Authorized Official

Name: M. HELEN CHIULLI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 770-287-0110