Provider Demographics
NPI:1871523399
Name:MACON LUNG CENTER PC
Entity type:Organization
Organization Name:MACON LUNG CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OYEKUMLE
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:MURAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-744-9603
Mailing Address - Street 1:560 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2824
Mailing Address - Country:US
Mailing Address - Phone:478-744-9603
Mailing Address - Fax:478-744-9552
Practice Address - Street 1:560 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-744-9603
Practice Address - Fax:478-744-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA246308625AMedicaid
GA246308625AMedicaid
GA511I290045Medicare PIN