Provider Demographics
NPI:1962707091
Name:SOUTHERN SLEEP SERVICES
Entity type:Organization
Organization Name:SOUTHERN SLEEP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT/CRTT
Authorized Official - Phone:229-221-2115
Mailing Address - Street 1:600 E GATE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-4254
Mailing Address - Country:US
Mailing Address - Phone:229-221-2115
Mailing Address - Fax:
Practice Address - Street 1:600 E GATE DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4254
Practice Address - Country:US
Practice Address - Phone:229-221-2115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic