Healthcare Provider Details

I. General information

NPI: 1396741120
Provider Name (Legal Business Name): LUNG CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 TROTWOOD AVE STE 601
COLUMBIA TN
38401-6410
US

IV. Provider business mailing address

1222 TROTWOOD AVE STE 601
COLUMBIA TN
38401-6410
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-7944
  • Fax: 931-380-1833
Mailing address:
  • Phone: 931-388-7944
  • Fax: 931-380-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15230
License Number StateTN

VIII. Authorized Official

Name: DR. M. MOATAZ TOBAN
Title or Position: PRESIDENT
Credential: MD
Phone: 931-388-7944