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General NPI Number Information
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NPI Number | 1386838621
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTA LUNG AND SLEEP CLINIC INC.
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 604A S 8TH ST
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City | GRIFFIN
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State | GA
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Zip | 30224-4214
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Country | US
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Telephone | 770-227-1999
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | LOCUST GROVE
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State | GA
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Zip | 30248-0326
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARI GOPAL MADICHETTY
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Credential | MD
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Telephone | 770-633-3843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 054405
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 054405
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 054405
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License Number State | GA
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