Provider Demographics
NPI:1093217085
Name:SLEEP GROUP SOUTH INC
Entity Type:Organization
Organization Name:SLEEP GROUP SOUTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:470-705-0788
Mailing Address - Street 1:1229 EAGLES LANDING PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5114
Mailing Address - Country:US
Mailing Address - Phone:470-705-0788
Mailing Address - Fax:470-203-2094
Practice Address - Street 1:1229 EAGLES LANDING PKWY STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5114
Practice Address - Country:US
Practice Address - Phone:470-705-0788
Practice Address - Fax:470-203-2094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8312122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty