Healthcare Provider Details

I. General information

NPI: 1366695835
Provider Name (Legal Business Name): SLEEP MEDICINE ASSOCIATES OF ATHENS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE SUITE 3100
ATHENS GA
30606-2179
US

IV. Provider business mailing address

1500 OGLETHORPE AVE SUITE 3100
ATHENS GA
30606-2179
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-6383
  • Fax: 706-850-6389
Mailing address:
  • Phone: 706-850-6383
  • Fax: 706-850-6389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number059704
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK DAS
Title or Position: MEDCAL DIRECTOR
Credential: M.D.
Phone: 706-850-6383