Healthcare Provider Details

I. General information

NPI: 1063505386
Provider Name (Legal Business Name): COLUMBUS LUNG PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HOSPITAL DR SUITE1
COLUMBUS MS
39705-1901
US

IV. Provider business mailing address

425 HOSPITAL DR SUITE1
COLUMBUS MS
39705-1901
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-8455
  • Fax: 662-327-8424
Mailing address:
  • Phone: 662-327-8455
  • Fax: 662-327-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN G TAYLOR
Title or Position: OWNER
Credential: M.D.
Phone: 662-327-8455