Provider Demographics
NPI:1063915338
Name:TRIDENT PULMONARY AND CRITICAL CARE PC
Entity type:Organization
Organization Name:TRIDENT PULMONARY AND CRITICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKINLOYE
Authorized Official - Middle Name:JULIUS
Authorized Official - Last Name:MAKANJUOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-545-8134
Mailing Address - Street 1:483 UPPER RIVERDALE RD SW STE E
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2579
Mailing Address - Country:US
Mailing Address - Phone:678-545-8134
Mailing Address - Fax:
Practice Address - Street 1:483 UPPER RIVERDALE RD SW STE E
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2579
Practice Address - Country:US
Practice Address - Phone:678-545-8134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty