Provider Demographics
NPI:1871787069
Name:SOUTHEAST LUNG AND CRITICAL CARE SPECIALIST
Entity type:Organization
Organization Name:SOUTHEAST LUNG AND CRITICAL CARE SPECIALIST
Other - Org Name:<UNAVAIL>
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:912-927-6270
Mailing Address - Street 1:340 HODGSON CT
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1520
Mailing Address - Country:US
Mailing Address - Phone:912-629-2290
Mailing Address - Fax:912-629-2291
Practice Address - Street 1:405 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1443
Practice Address - Country:US
Practice Address - Phone:912-819-5757
Practice Address - Fax:912-819-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
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
GA000148519LMedicaid
GA696088793AMedicaid
GA000526336AMedicaid
GA000788818LMedicaid
GA000914922AMedicaid
GA487007710AMedicaid
GA202I294672Medicare PIN
GA000526336AMedicaid
GA696088793AMedicaid
GA202I114674Medicare PIN
GA29BDCFNMedicare PIN
GA11SCHRFMedicare PIN