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NPI 1366607921

NPI 1366607921 : OCONEE SLEEP CENTER, LLC : VIDALIA, GA

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General NPI Number Information
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    NPI Number           |    1366607921
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    Entity Type          |    Organization 
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    Legal Business Name  |    OCONEE SLEEP CENTER, LLC 
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Dates
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    Enumeration Date     |    07/23/2008
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    Last Update Date     |    01/14/2025
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Provider Practice Location Address
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    Address Line         |    602 CHURCH ST UNIT B 
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    City                 |    VIDALIA
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    State                |    GA
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    Zip                  |    30474-4744
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    Country              |    US
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    Telephone            |    912-388-4556
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    Fax                  |    912-538-8404
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Provider Business Mailing Address
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    Address Line         |    602 CHURCH ST UNIT B 
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    City                 |    VIDALIA
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    State                |    GA
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    Zip                  |    30474-4744
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    Country              |    US
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    Telephone            |    912-388-4556
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    Fax                  |    912-538-8404
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Authorized Official
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    Title or Position    |    OPERATIONS MANAGER
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    Name                 |     MIKE S SHEHEE 
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    Credential           |    
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    Telephone            |    912-388-4556
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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       |    2008108051
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    License Number State |    GA
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Taxonomy #2
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    Taxonomy Code        |    261QS1200X
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    Taxonomy Name        |    Sleep Disorder Diagnostic Clinic/Center
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    License Number       |    
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    License Number State |    
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