Provider Demographics
NPI:1225201494
Name:ANDREW V CICHELLI MD INC
Entity Type:Organization
Organization Name:ANDREW V CICHELLI MD INC
Other - Org Name:EAST GEORGIA PULMONARY & SLEEP DISORDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-681-4911
Mailing Address - Street 1:1601 FAIR RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1698
Mailing Address - Country:US
Mailing Address - Phone:912-681-4911
Mailing Address - Fax:912-681-6911
Practice Address - Street 1:1601 FAIR RD
Practice Address - Street 2:SUITE 600
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1698
Practice Address - Country:US
Practice Address - Phone:912-681-4911
Practice Address - Fax:912-681-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1225201494OtherNPI