Provider Demographics
NPI:1306142070
Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Entity type:Organization
Organization Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-6614
Mailing Address - Street 1:340 EISENHOWER DR
Mailing Address - Street 2:BLDG. 1500
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1600
Mailing Address - Country:US
Mailing Address - Phone:912-354-6614
Mailing Address - Fax:912-356-9078
Practice Address - Street 1:131 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4641
Practice Address - Country:US
Practice Address - Phone:912-354-6614
Practice Address - Fax:912-356-9078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI7230OtherRAILROAD MEDICARE
GACI9902OtherRAILROAD MEDICARE
GACI7230OtherRAILROAD MEDICARE
G43370Medicare UPIN
GAA53401Medicare UPIN
GACI9902OtherRAILROAD MEDICARE
GAGRP3039Medicare PIN
GAE60737Medicare UPIN