Organization
SOUTH ATLANTA LUNG AND SLEEP CLINIC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HARI GOPAL MADICHETTY MD (OWNER)
(770) 633-3843
Entity
Organization
Contact information
Practice address
604A S 8TH ST, GRIFFIN, GA 30224-4214
(770) 227-1999
Mailing address
PO BOX 326, LOCUST GROVE, GA 30248-0326
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
054405
GA
207RP1001X
Pulmonary Disease Physician
Primary
054405
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
054405
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
919846878A
—
GA
Enumeration date
08/29/2007
Last updated
07/29/2019
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