Provider Demographics
NPI:1902935281
Name:SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC
Other - Org Name:DUBLIN SURGICAL ASSOCIATES AND HEART OF GEORGIA SLEEP MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-420-0456
Mailing Address - Street 1:1101-L HILLCREST PKWY
Mailing Address - Street 2:PMB #325
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3581
Mailing Address - Country:US
Mailing Address - Phone:855-811-6362
Mailing Address - Fax:478-277-0276
Practice Address - Street 1:3333 NORTHSIDE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2590
Practice Address - Country:US
Practice Address - Phone:478-272-4544
Practice Address - Fax:478-275-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039475174400000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000786354BMedicaid
GA000786354PMedicaid
GA000786354BMedicaid
GA000786354PMedicaid