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NPI Code Detail

MEDICARE: SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC

MEDICARE: SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
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
1207RP1001XPulmonary Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750651865
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC
Provider Business Mailing Address
First Line : 340 HODGSON CT
Second Line : SUITE #2
City : SAVANNAH
State : GA
Zip : 31406-1520
Country : US
Telephone Number : 912-629-2290
Fax Number : 912-629-2291
Provider Business Practice Location Address
First Line : 1006 MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-927-6270
Fax Number : 912-927-6254
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : APRIL YOUNG
Credential :
Telephone Number : 912-629-0457
Provider Enumeration Date : 01/05/2012
Last Update Date : 01/23/2014

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Directions to “SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, PC ” Practice Location

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