Basic Information
| Provider Information | |||||||||
| NPI: | 1447445150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST LUNG AND CRITICAL CARE SPECIALIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 EISENHOWER DR | ||||||||
| Address2: | BLDG. 1500 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314061600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546614 | ||||||||
| FaxNumber: | 9123569078 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LISTER ST | ||||||||
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| City: | WAYCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 315015226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546614 | ||||||||
| FaxNumber: | 9123569078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | STRICKLAND | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9123546614 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
No ID Information.