1972709483 NPI number — SLEEP SERVICES OF AMERICA INC.

Table of content: (NPI 1972709483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972709483 NPI number — SLEEP SERVICES OF AMERICA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLEEP SERVICES OF AMERICA INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTHERN SLEEP TECHNOLOGIES
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972709483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
430 WOODRUFF RD
Provider Second Line Business Mailing Address:
SUITE 450
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-3495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-527-5970
Provider Business Mailing Address Fax Number:
864-527-5971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4524 FORSYTH RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-4545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-757-0759
Provider Business Practice Location Address Fax Number:
478-757-0769
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MELLOTT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
864-527-5970

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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