Organization
SOUTHERN SLEEP TECHNOLOGIES, INC
Active
Other names
SOUTHERN HOME RESPIRATORY CARE INC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK SHANE MOBLEY RRT, PSBT (CEO)
(478) 757-0759
Entity
Organization
Contact information
Practice address
215 SHERATON BLVD STE A, MACON, GA 31210-1359
(478) 757-0759
(478) 757-0769
Mailing address
215 SHERATON BLVD STE A, MACON, GA 31210-1359
(478) 757-0759
(478) 757-0769
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
02893
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52047683002
BCBS
GA
01
—
P00121319
RR MEDICARE
GA
Enumeration date
06/08/2005
Last updated
08/17/2007
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