Healthcare Provider Details

I. General information

NPI: 1417358136
Provider Name (Legal Business Name): ATHENS LIMESTONE SLEEP CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SANDERS ST
ATHENS AL
35611-1419
US

IV. Provider business mailing address

205 SANDERS ST
ATHENS AL
35611-1419
US

V. Phone/Fax

Practice location:
  • Phone: 256-771-7378
  • Fax: 256-233-9572
Mailing address:
  • Phone: 256-771-7378
  • Fax: 256-233-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SEBRINA B HOLT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 256-216-9648