Healthcare Provider Details

I. General information

NPI: 1073827374
Provider Name (Legal Business Name): CHILDREN'S LUNG AND SLEEP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WATERS AVE SUITE 301
SAVANNAH GA
31404-6200
US

IV. Provider business mailing address

4750 WATERS AVE SUITE 301
SAVANNAH GA
31404-6200
US

V. Phone/Fax

Practice location:
  • Phone: 912-721-0050
  • Fax: 912-721-0051
Mailing address:
  • Phone: 912-721-0050
  • Fax: 912-721-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number050404
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number050404
License Number StateGA

VIII. Authorized Official

Name: DR. GORDANA LOVREKOVIC-ZAKULA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 706-825-2586