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General NPI Number Information
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NPI Number | 1689814626
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Entity Type | Organization
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Legal Business Name | LUNG CENTER OF DUBLIN
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 200 FAIRVIEW PARK DR
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City | DUBLIN
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State | GA
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Zip | 31021-2547
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Country | US
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Telephone | 478-275-0792
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Fax | 478-275-0713
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Provider Business Mailing Address
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Address Line | PO BOX 16190
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City | DUBLIN
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State | GA
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Zip | 31040-6190
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Country | US
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Telephone | 478-275-0792
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Fax | 478-275-0713
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AYN VINCENT BAYANI
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Credential | M.D.
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Telephone | 478-275-0792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 055470
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License Number State | GA
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