Provider Demographics
NPI:1790101939
Name:ATHENS SLEEP THERAPY LLC
Entity Type:Organization
Organization Name:ATHENS SLEEP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOBBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-639-1028
Mailing Address - Street 1:1080 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-2332
Mailing Address - Country:US
Mailing Address - Phone:770-639-1028
Mailing Address - Fax:
Practice Address - Street 1:500 PANTHER DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-5400
Practice Address - Country:US
Practice Address - Phone:706-367-9861
Practice Address - Fax:706-367-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011322122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty