Healthcare Provider Details

I. General information

NPI: 1649455189
Provider Name (Legal Business Name): SLEEPMED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SECOND ST SUITE 430
MACON GA
31201-2624
US

IV. Provider business mailing address

60 CHASTAIN CENTER BLVD NW STE 66
KENNESAW GA
30144-5598
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-5779
  • Fax: 478-742-7796
Mailing address:
  • Phone: 978-536-7400
  • Fax:

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 Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH ROSE
Title or Position: VP OF FINANCE & ADMINISTRATION
Credential:
Phone: 978-536-7400