Healthcare Provider Details

I. General information

NPI: 1104904135
Provider Name (Legal Business Name): LUNG ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 SHRINE RD SUITE B
BRUNSWICK GA
31520-4325
US

IV. Provider business mailing address

3222 SHRINE RD SUITE B
BRUNSWICK GA
31520-4325
US

V. Phone/Fax

Practice location:
  • Phone: 912-267-7607
  • Fax: 912-261-2800
Mailing address:
  • Phone: 912-267-7607
  • Fax: 912-261-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KAYCEE NICHOLE PRICE
Title or Position: OFFICE MANAGER
Credential:
Phone: 912-267-7607