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General NPI Number Information
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NPI Number | 1912196775
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Entity Type | Organization
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Legal Business Name | GEORGIA PULMONARY GROUP PC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 1800 TREE LN SUITE 200
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City | SNELLVILLE
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State | GA
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Zip | 30078-2016
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Country | US
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Telephone | 770-979-0367
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Fax | 770-979-1830
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Provider Business Mailing Address
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Address Line | 1800 TREE LN SUITE 200
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City | SNELLVILLE
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State | GA
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Zip | 30078-2016
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Country | US
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Telephone | 770-979-0367
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Fax | 770-979-1830
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TERRI L MCCLESKEY
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Credential |
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Telephone | 770-979-2062
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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 | 36567
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License Number State | GA
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Taxonomy #2
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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 | 36567
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 36567
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License Number State | GA
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