Healthcare Provider Details

I. General information

NPI: 1396867800
Provider Name (Legal Business Name): SOUTHERN SLEEP CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N WILEY AVE
DONALSONVILLE GA
39845-1340
US

IV. Provider business mailing address

502 N WILEY AVE
DONALSONVILLE GA
39845-1340
US

V. Phone/Fax

Practice location:
  • Phone: 229-524-2259
  • Fax: 229-524-2269
Mailing address:
  • Phone: 229-524-2259
  • Fax: 229-524-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number1061
License Number StateGA

VIII. Authorized Official

Name: MICHAEL J LABANOWSKI
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 334-791-1700