Basic Information
| Provider Information | |||||||||
| NPI: | 1326057001 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDDLE TENNESSEE CENTER FOR LUNG DISEASE, PC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 MEDICAL CENTER PKWY STE 310 | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158499868 | ||||||||
| FaxNumber: | 6158981882 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 MEDICAL CENTER PKWY STE 310 | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158499868 | ||||||||
| FaxNumber: | 6158981882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 12/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6158499868 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.