Healthcare Provider Details

I. General information

NPI: 1134472384
Provider Name (Legal Business Name): THE LUNG CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 WALNUT GROVE RD.
MEMPHIS TN
38120-0000
US

IV. Provider business mailing address

PO BOX 440107
NASHVILLE TN
37244-0107
US

V. Phone/Fax

Practice location:
  • Phone: 901-753-8361
  • Fax: 901-756-8541
Mailing address:
  • Phone: 901-753-8361
  • Fax: 901-756-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39269
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number39269
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number39269
License Number StateTN

VIII. Authorized Official

Name: DR. SANJAY RATNAKANT
Title or Position: OWNER
Credential: MD
Phone: 901-753-8361