NPIMap

Organization Active NPI

Southeast Lung & Critical Care Specialists

  • Pulmonary Disease Physician
  • Douglas, GA
National Provider Identifier
1790015253
Registry record updated Jan 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036358 Issued in GA
Legal business name
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Practice address
200 Doctors Dr
Ste. 112
Douglas, GA 31533-2201
Phone
(912) 354-6614
Fax
(912) 356-9078
NPI assigned
Jan 6, 2010
Last updated
Jan 6, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
April Young
Title
Practice Manager
Phone
(912) 354-6614

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 036358 GA Primary
Sleep Specialist (PhD) 173F00000X 036358 GA

Addresses

Primary practice location

200 Doctors Dr
Ste. 112
Douglas, GA 31533-2201

Mailing address

340 Eisenhower Dr
BLDG. 1500
Savannah, GA 31406-1600
Phone (912) 354-6614

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000176 GA Part B Supplier - Clinic/Group Practice 7618962291 Receives reassigned benefits from 29 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jesup, GA; Vidalia, GA; Tybee Island, GA; Sylvania, GA; Springfield, GA; Savannah, GA; Hinesville, GA; Brunswick, GA…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory

Locations

200 Doctors Dr
Ste O
Douglas, GA 31533
Phone (912) 383-5655

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1790015253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 EISENHOWER DR",
            "address_2": "BLDG. 1500",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314061600",
            "telephone_number": "912-354-6614",
            "fax_number": "912-356-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DOCTORS DR",
            "address_2": "STE. 112",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332201",
            "telephone_number": "912-354-6614",
            "fax_number": "912-356-9078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-06",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "912-354-6614"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "036358",
            "primary": true
        },
        {
            "code": "173F00000X",
            "taxonomy_group": "",
            "desc": "Sleep Specialist, PhD",
            "state": "GA",
            "license": "036358",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.