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General NPI Number Information
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NPI Number | 1770881021
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Entity Type | Organization
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Legal Business Name | UNIVERSAL LUNG ASSOCIATES
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE SUITE 1285
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City | ATLANTA
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State | GA
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Zip | 30308-2208
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Country | US
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Telephone | 404-856-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE ST NE SUITE 1285
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City | ATLANTA
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State | GA
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Zip | 30308-2208
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Country | US
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Telephone | 404-856-3216
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. OLUFUNSHO OLADIPO BANKOLE
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Credential | M.D
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Telephone | 806-290-0485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 58391
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License Number State | GA
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