Healthcare Provider Details

I. General information

NPI: 1154628683
Provider Name (Legal Business Name): SOUTHERN SLEEP CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E THREE NOTCH ST
ANDALUSIA AL
36420-3128
US

IV. Provider business mailing address

2346 W MAIN ST STE 3
DOTHAN AL
36301-1276
US

V. Phone/Fax

Practice location:
  • Phone: 334-222-3700
  • Fax: 334-222-3720
Mailing address:
  • Phone: 334-673-2501
  • Fax: 334-673-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number27742
License Number StateAL

VIII. Authorized Official

Name: MICHAEL J LABANOWSKI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 334-673-2501