Healthcare Provider Details

I. General information

NPI: 1295903490
Provider Name (Legal Business Name): HEART OF GEORGIA SLEEP MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 HILLCREST PKWY STE 1
DUBLIN GA
31021-4259
US

IV. Provider business mailing address

PO BOX 4525
MACON GA
31208-4525
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-4544
  • Fax: 478-275-1306
Mailing address:
  • Phone: 478-272-4544
  • Fax: 478-275-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAMELA A NOLES
Title or Position: OWNER
Credential: RPSGT
Phone: 478-272-4544