Basic Information
| Provider Information | |||||||||
| NPI: | 1720009244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PULMONARY & SLEEP MEDICINE ASSOCIATES, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 915 EAGLES LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709966699 | ||||||||
| FaxNumber: | 7709974790 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 EAGLES LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709966699 | ||||||||
| FaxNumber: | 7709974790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | RASTOGI | ||||||||
| AuthorizedOfficialFirstName: | PRAVEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7709966699 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 03/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 710561989A | 05 | GA | MEDICAID | 00178813B | 05 | GA | MEDICAID | 00713138B | 05 | GA | MEDICAID | 00286668A | 05 | GA | MEDICAID | 919846878A | 05 | GA | MEDICAID |