Organization
SOUTHEAST LUNG & CRITICAL CARE SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA MASCOLO III M.D. (PARTNER)
(912) 354-6614
Entity
Organization
Contact information
Practice address
209C MIMS RD, SYLVANIA, GA 30467-1994
(912) 564-5977
(912) 564-1259
Mailing address
340 EISENHOWER DR, BUILDING #1500, SAVANNAH, GA 31406-1600
(912) 354-6614
(912) 356-9078
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
052469
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
487007710A
—
GA
Enumeration date
03/22/2010
Last updated
03/22/2010
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