Provider Demographics
NPI:1720009244
Name:PULMONARY & SLEEP MEDICINE ASSOCIATES, LLP
Entity type:Organization
Organization Name:PULMONARY & SLEEP MEDICINE ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTOGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-6699
Mailing Address - Street 1:915 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5011
Mailing Address - Country:US
Mailing Address - Phone:770-996-6699
Mailing Address - Fax:770-997-4790
Practice Address - Street 1:915 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5011
Practice Address - Country:US
Practice Address - Phone:770-996-6699
Practice Address - Fax:770-997-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA710561989AMedicaid
GA00178813BMedicaid
GA00713138BMedicaid
GA00286668AMedicaid
GA919846878AMedicaid
GAG34987Medicare UPIN
GA81BBBCMMedicare ID - Type UnspecifiedMEDICARE
GAD30073Medicare UPIN
GA155405199BMedicare ID - Type UnspecifiedMEDICARE
GA00713138BMedicaid
GA29BDBZGMedicare ID - Type UnspecifiedMEDICARE
GA29BDCBRMedicare ID - Type UnspecifiedMEDICARE
GA00286668AMedicaid
GA919846878AMedicaid
GA81BBBCQMedicare ID - Type UnspecifiedMEDICARE
GA29BDBZFMedicare ID - Type UnspecifiedMEDCIARE
GA269743292AMedicare ID - Type UnspecifiedMEDICARE
GA710561989AMedicaid