Provider Demographics
NPI:1629263330
Name:SOUTHEAST LUNG AND CRITICAL CARE SPECIALIST
Entity Type:Organization
Organization Name:SOUTHEAST LUNG AND CRITICAL CARE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:W
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 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0211
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:2007-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA53401Medicare UPIN
GAG43370Medicare UPIN