Provider Demographics
NPI:1225032261
Name:SOUTHERN SLEEP TECHNOLOGIES, INC
Entity Type:Organization
Organization Name:SOUTHERN SLEEP TECHNOLOGIES, INC
Other - Org Name:SOUTHERN HOME RESPIRATORY CARE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, PSBT
Authorized Official - Phone:478-757-0759
Mailing Address - Street 1:215 SHERATON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1359
Mailing Address - Country:US
Mailing Address - Phone:478-757-0759
Mailing Address - Fax:478-757-0769
Practice Address - Street 1:215 SHERATON BLVD STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1359
Practice Address - Country:US
Practice Address - Phone:478-757-0759
Practice Address - Fax:478-757-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02893261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00121319OtherRR MEDICARE
GA52047683002OtherBCBS
GA47BBBHHMedicare ID - Type Unspecified