MEDICARE: CAROLINA LUNG ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1679562805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA LUNG ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	2097 HENRY TECKLENBURG DR
Second Line	:	STE 305
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5740
Country	:	US
Telephone Number	:	843-763-3360
Fax Number	:	843-763-3038

Provider Business Practice Location Address
First Line	:	2097 HENRY TECKLENBURG DR
Second Line	:	STE 305
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5740
Country	:	US
Telephone Number	:	843-763-3360
Fax Number	:	843-763-3038

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. NICOLE SHEA
Credential	:
Telephone Number	:	843-763-3360

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/11/2025

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