Provider Demographics
NPI:1518237510
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:MR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-374-1900
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:478-374-1900
Mailing Address - Fax:478-374-1904
Practice Address - Street 1:830 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6734
Practice Address - Country:US
Practice Address - Phone:478-374-1900
Practice Address - Fax:478-374-1904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic