Provider Demographics
NPI:1740244276
Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS, P.C.
Other - Org Name:SOUTHEAST LUNG ASSOCIATES
Other - Org Type:Doing Business As
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:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-629-2290
Mailing Address - Street 1:PO BOX 14417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1417
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:340 HODGSON CT
Practice Address - Street 2:SUITE #2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1520
Practice Address - Country:US
Practice Address - Phone:912-629-2290
Practice Address - Fax:912-629-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACI7230OtherRAILROAD MEDICARE
SCCI9902OtherRAILROAD MEDICARE
GAGRP3039Medicare PIN
GAA53401Medicare UPIN
GAG43370Medicare UPIN
GA29BDBXPMedicare ID - Type Unspecified
GAG69315Medicare UPIN
SC6167Medicare PIN
GAE60737Medicare UPIN