Healthcare Provider Details

I. General information

NPI: 1902935281
Provider Name (Legal Business Name): SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 NORTHSIDE DRIVE SUITE B
MACON GA
31210-2590
US

IV. Provider business mailing address

1101-L HILLCREST PKWY PMB #325
DUBLIN GA
31021-3581
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-4544
  • Fax: 478-275-1306
Mailing address:
  • Phone: 855-811-6362
  • Fax: 478-277-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number039475
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number039475
License Number StateGA

VIII. Authorized Official

Name: DAWN DREW
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 478-420-0456