MEDICARE: NATIONS SLEEP DISORDERS CENTER OF THE CAROLINAS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1437782109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONS SLEEP DISORDERS CENTER OF THE CAROLINAS LLC

Provider Business Mailing Address
First Line	:	463 POOLER PKWY # 163
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-5102
Country	:	US
Telephone Number	:	912-631-2581
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 GUM BRANCH RD STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-6427
Country	:	US
Telephone Number	:	478-363-9250
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	PAUL NOLES
Credential	:
Telephone Number	:	478-363-9250

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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