Healthcare Provider Details

I. General information

NPI: 1942768536
Provider Name (Legal Business Name): SLIIIP MEDICAL GROUP P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 GA HIGHWAY 49 N STE 1900
BYRON GA
31008-4059
US

IV. Provider business mailing address

212 GA HIGHWAY 49 N STE 1900
BYRON GA
31008-4059
US

V. Phone/Fax

Practice location:
  • Phone: 478-238-3552
  • Fax: 478-259-6170
Mailing address:
  • Phone: 478-238-3552
  • Fax: 478-259-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: AVINESH SINGH BHAR JASWINDAR SINGH
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 478-238-3552