NPIMap

Organization Active NPI

Southeastern Surgery & Sleep Apnea Treatment Ctr. LLC

  • General Practice Physician
  • Macon, GA
National Provider Identifier
1902935281
Registry record updated Aug 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
039475 Issued in GA
Legal business name
SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC
Practice address
3333 Northside Drive
Suite B
Macon, GA 31210-2590
Phone
(478) 272-4544
Fax
(478) 275-1306
NPI assigned
Mar 5, 2007
Last updated
Aug 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dawn Drew
Title
Chief Financial Officer
Phone
(478) 420-0456

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 039475 GA
General Practice Physician 208D00000X 039475 GA Primary

Addresses

Primary practice location

3333 Northside Drive
Suite B
Macon, GA 31210-2590

Mailing address

1101-L Hillcrest Pkwy
PMB #325
Dublin, GA 31021-3581
Phone (855) 811-6362

Other identifiers 2

IdentifierTypeStateIssuer
000786354PMedicaidGA
000786354BMedicaidGA

Other names 1

  • Dublin Surgical Associates and Heart of Georgia Sleep Medicine Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040917001066 GA Part B Supplier - Clinic/Group Practice 9436061082 Receives reassigned benefits from 14 practitioners
Practice locations: Dublin, GA; Eastman, GA; McRae, GA; Milledgeville, GA; Swainsboro, GA

National Provider Directory

National Provider Directory

Locations

102 Corporate Sq
Ste G
Dublin, GA 31021
Phone (478) 420-0456

3333 Northside Dr
Ste B
Macon, GA 31210
Phone (478) 272-4544

1909 N Columbia St
Milledgeville, GA 31061
Phone (478) 295-3000

120 Jackson St
Swainsboro, GA 30401
Phone (478) 237-7246

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438819200000",
    "number": "1902935281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101-L HILLCREST PKWY",
            "address_2": "PMB #325",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310213581",
            "telephone_number": "855-811-6362",
            "fax_number": "478-277-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 NORTHSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102590",
            "telephone_number": "478-272-4544",
            "fax_number": "478-275-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN SURGERY & SLEEP APNEA TREATMENT CTR. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2015-08-06",
        "status": "A",
        "authorized_official_last_name": "DREW",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "478-420-0456"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "039475",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "039475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000786354P",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000786354B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dublin Surgical Associates and Heart of Georgia Sleep Medicine",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Macon, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.