Provider Demographics
NPI:1821289901
Name:COASTAL RESPIRATORY ASSOCIATES
Entity Type:Organization
Organization Name:COASTAL RESPIRATORY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIFFORD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-352-4777
Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6007
Mailing Address - Country:US
Mailing Address - Phone:912-352-4111
Mailing Address - Fax:912-629-0457
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:SUITE 318
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6007
Practice Address - Country:US
Practice Address - Phone:912-352-4111
Practice Address - Fax:912-629-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3015Medicare PIN