Healthcare Provider Details

I. General information

NPI: 1508662537
Provider Name (Legal Business Name): SLEEP CENTER OF MOULTRIE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S MAIN ST
MOULTRIE GA
31768-5811
US

IV. Provider business mailing address

PO BOX 2
MOULTRIE GA
31776-0002
US

V. Phone/Fax

Practice location:
  • Phone: 229-785-2335
  • Fax:
Mailing address:
  • Phone: 229-561-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIM M TOMLINSON
Title or Position: AM
Credential:
Phone: 229-891-5308