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NPI Code Detail

MEDICARE: SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS

MEDICARE: SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
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
1173F00000XSleep Specialist (PhD)

General Provider Information

NPI Number : 1871823187
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Provider Business Mailing Address
First Line : 340 EISENHOWER DR
Second Line : BLDG. 1500
City : SAVANNAH
State : GA
Zip : 31406-1600
Country : US
Telephone Number : 912-354-6614
Fax Number : 912-356-9078
Provider Business Practice Location Address
First Line : 131 MEMORIAL DR
Second Line :
City : REIDSVILLE
State : GA
Zip : 30453-4641
Country : US
Telephone Number : 912-354-6614
Fax Number : 912-356-9078
Authorized Official
Title or Position : PRACTICE MANAGER
Name : APRIL YOUNG
Credential :
Telephone Number : 912-354-6614
Provider Enumeration Date : 01/08/2010
Last Update Date : 01/08/2010

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

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