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General NPI Number Information
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NPI Number | 1679871099
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Entity Type | Organization
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Legal Business Name | WALTON PULMONARY & SLEEP MEDICINE PC
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 101 TARA COMMONS DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-8018
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Country | US
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Telephone | 678-928-9700
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Fax | 770-466-1585
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Provider Business Mailing Address
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Address Line | 101 TARA COMMONS DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-8018
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Country | US
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Telephone | 678-928-9700
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Fax | 770-466-1585
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHEL JEANNOT
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Credential | MD
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Telephone | 678-928-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 065686
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 065686
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License Number State | GA
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