Healthcare Provider Details

I. General information

NPI: 1093894685
Provider Name (Legal Business Name): COSTRINI SLEEP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11909 MCAULEY DR UNIT A1
SAVANNAH GA
31419-1794
US

IV. Provider business mailing address

11909 MCAULEY DR UNIT A1
SAVANNAH GA
31419-1794
US

V. Phone/Fax

Practice location:
  • Phone: 912-927-6680
  • Fax: 912-927-0062
Mailing address:
  • Phone: 912-927-6680
  • Fax: 912-927-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number014476
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number20011763092
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number014476
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier829165487A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MRS. LYNETTE GRAYSON
Title or Position: ADMINISTRATIVE COORDINATOR
Credential:
Phone: 912-927-6680