Provider Demographics
NPI:1093894685
Name:COSTRINI SLEEP SERVICES
Entity Type:Organization
Organization Name:COSTRINI SLEEP SERVICES
Other - Org Name:GOOD SLEEP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-927-6680
Mailing Address - Street 1:11909 MCAULEY DR UNIT A1
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1794
Mailing Address - Country:US
Mailing Address - Phone:912-927-6680
Mailing Address - Fax:912-927-0062
Practice Address - Street 1:11909 MCAULEY DR UNIT A1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1794
Practice Address - Country:US
Practice Address - Phone:912-927-6680
Practice Address - Fax:912-927-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014476173F00000X, 207RP1001X
GA20011763092332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA829165487AMedicaid
GA829165487AMedicaid
GA5419700001Medicare NSC