Provider Demographics
NPI:1285822478
Name:SOUTHERN SLEEP TECHNOLOGIES, INC
Entity Type:Organization
Organization Name:SOUTHERN SLEEP TECHNOLOGIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-760-6990
Mailing Address - Street 1:890 AIRPORT PARK RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2559
Mailing Address - Country:US
Mailing Address - Phone:410-760-6990
Mailing Address - Fax:410-760-9497
Practice Address - Street 1:1570 WATSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3432
Practice Address - Country:US
Practice Address - Phone:478-757-0759
Practice Address - Fax:478-757-0769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SLEEP SERVICES OF AMERICA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07039337261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1186230001Medicare PIN