Provider Demographics
NPI:1043521859
Name:SOUTHEST LUNG & CRITICAL CARE SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHEST LUNG & CRITICAL CARE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-6614
Mailing Address - Street 1:340 EISENHOWER DR
Mailing Address - Street 2:BUILDING 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 1:1821B OLD OCILLA ROAD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
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:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036358173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCI9902OtherRAILROAD MEDICARE
GACI7230OtherRAILROAD MEDICARE
GA6167Medicare PIN
GACI7230OtherRAILROAD MEDICARE
GAG43370Medicare UPIN
GAE60737Medicare UPIN
GAA53401Medicare UPIN
GAGRP3039Medicare PIN