Provider Demographics
NPI:1073827374
Name:CHILDREN'S LUNG AND SLEEP ASSOCIATES
Entity Type:Organization
Organization Name:CHILDREN'S LUNG AND SLEEP ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVREKOVIC-ZAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-825-2586
Mailing Address - Street 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-721-0050
Mailing Address - Fax:912-721-0051
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-721-0050
Practice Address - Fax:912-721-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0504042080P0214X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000910962GMedicaid
GA1891763744OtherNPI
GAH41746Medicare UPIN