=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740244276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 HODGSON CT SUITE #2
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31406-1520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-629-2290
-----------------------------------------------------
Fax | 912-629-2291
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14417
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31416-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-629-2290
-----------------------------------------------------
Fax | 912-629-2291
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. JAMES A DALY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 912-629-2290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 032635
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------