Provider Demographics
NPI:1114277373
Name:MIDDLE GEORGIA SLEEP & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:MIDDLE GEORGIA SLEEP & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-744-9936
Mailing Address - Street 1:PO BOX 4640
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-4640
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 HOSPITAL DRIVE
Practice Address - Street 2:BUILDING D SUITE 120
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-0000
Practice Address - Country:US
Practice Address - Phone:478-744-9936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45-4054629246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty