Basic Information
| Provider Information | |||||||||
| NPI: | 1023441656 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SLEEP PRACTITIONERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 SHERATON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455779 | ||||||||
| FaxNumber: | 4787427796 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 SHERATON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787455779 | ||||||||
| FaxNumber: | 4787427796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2013 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4787455779 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
No ID Information.