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General NPI Number Information
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NPI Number | 1902935281
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 3333 NORTHSIDE DRIVE SUITE B
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City | MACON
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State | GA
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Zip | 31210-2590
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Country | US
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Telephone | 478-272-4544
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Fax | 478-275-1306
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Provider Business Mailing Address
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Address Line | 1101-L HILLCREST PKWY PMB #325
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City | DUBLIN
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State | GA
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Zip | 31021-3581
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Country | US
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Telephone | 855-811-6362
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Fax | 478-277-0276
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DAWN DREW
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Credential |
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Telephone | 478-420-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 039475
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 039475
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License Number State | GA
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