Provider Demographics
NPI:1700898871
Name:SOUTH GEORGIA LUNG SPECIALISTS,PC
Entity Type:Organization
Organization Name:SOUTH GEORGIA LUNG SPECIALISTS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:MANEL
Authorized Official - Middle Name:DINESH
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-287-0333
Mailing Address - Street 1:PO BOX 1525
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-1525
Mailing Address - Country:US
Mailing Address - Phone:912-287-0333
Mailing Address - Fax:
Practice Address - Street 1:1406 HABERSHAM DR
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5306
Practice Address - Country:US
Practice Address - Phone:912-287-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300034294AMedicaid
GRP3348Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER