Provider Demographics
NPI:1104989136
Name:GEORGIA LUNG ASSOCIATES PC
Entity type:Organization
Organization Name:GEORGIA LUNG ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROYLES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:770-948-6774
Mailing Address - Street 1:3820 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1110
Mailing Address - Country:US
Mailing Address - Phone:770-948-6041
Mailing Address - Fax:770-948-2736
Practice Address - Street 1:3820 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1110
Practice Address - Country:US
Practice Address - Phone:770-948-6041
Practice Address - Fax:770-948-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty