Provider Demographics
NPI:1174668701
Name:CERTIFIED SLEEP SPECIALISTS, LLC
Entity type:Organization
Organization Name:CERTIFIED SLEEP SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:229-293-0037
Mailing Address - Street 1:1725 E PARK AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-3420
Mailing Address - Country:US
Mailing Address - Phone:229-293-0037
Mailing Address - Fax:229-293-0701
Practice Address - Street 1:1601 N ASHLEY ST
Practice Address - Street 2:SUITE 83
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-3055
Practice Address - Country:US
Practice Address - Phone:229-293-0037
Practice Address - Fax:229-293-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0287352084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00463273KMedicaid
GA00463273KMedicaid
GAE85908Medicare UPIN