Provider Demographics
NPI:1538347950
Name:CSRA SLEEP LLC
Entity type:Organization
Organization Name:CSRA SLEEP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-376-4760
Mailing Address - Street 1:590 PONCE DE LEON AVE NE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1834
Mailing Address - Country:US
Mailing Address - Phone:404-376-4760
Mailing Address - Fax:404-593-2811
Practice Address - Street 1:2917 PROFESSIONAL PKWY STE D
Practice Address - Street 2:D
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3538
Practice Address - Country:US
Practice Address - Phone:706-863-2182
Practice Address - Fax:404-593-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000501332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies