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General NPI Number Information
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NPI Number | 1225032261
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Entity Type | Organization
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Legal Business Name | SOUTHERN SLEEP TECHNOLOGIES, INC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 215 SHERATON BLVD STE A
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City | MACON
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State | GA
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Zip | 31210-1359
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Country | US
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Telephone | 478-757-0759
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Fax | 478-757-0769
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Provider Business Mailing Address
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Address Line | 215 SHERATON BLVD STE A
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City | MACON
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State | GA
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Zip | 31210-1359
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Country | US
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Telephone | 478-757-0759
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Fax | 478-757-0769
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK SHANE MOBLEY
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Credential | RRT, PSBT
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Telephone | 478-757-0759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number | 02893
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License Number State | GA
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