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General NPI Number Information
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NPI Number | 1396867800
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Entity Type | Organization
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Legal Business Name | SOUTHERN SLEEP CLINICS LLC
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 502 N WILEY AVE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1340
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Country | US
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Telephone | 229-524-2259
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Fax | 229-524-2269
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Provider Business Mailing Address
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Address Line | 502 N WILEY AVE
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City | DONALSONVILLE
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State | GA
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Zip | 39845-1340
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Country | US
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Telephone | 229-524-2259
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Fax | 229-524-2269
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Authorized Official
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Title or Position | OWNER MEDICAL DIRECTOR
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Name | MICHAEL J LABANOWSKI
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Credential | MD
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Telephone | 334-791-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 1061
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License Number State | GA
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