Healthcare Provider Details

I. General information

NPI: 1083344576
Provider Name (Legal Business Name): ZODIAC MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MCKENDREE CHURCH RD STE 202
LAWRENCEVILLE GA
30043-5207
US

IV. Provider business mailing address

1180 MCKENDREE CHURCH RD STE 202
LAWRENCEVILLE GA
30043-5207
US

V. Phone/Fax

Practice location:
  • Phone: 470-292-3122
  • Fax: 404-738-1614
Mailing address:
  • Phone: 470-292-3122
  • Fax: 404-738-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONG VIEN DANG
Title or Position: OWNER
Credential: MD
Phone: 470-633-1970