MEDICARE: TOTAL SLEEP DIAGNOSTICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1912230582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL SLEEP DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1425 GREENWAY DR
Second Line	:	STE 300
City	:	IRVING
State	:	TX
Zip	:	75038-2447
Country	:	US
Telephone Number	:	469-499-2857
Fax Number	:	469-499-2806

Provider Business Practice Location Address
First Line	:	3200 COBB GALLERIA PKWY
Second Line	:	STE 245
City	:	ATLANTA
State	:	GA
Zip	:	30339-5927
Country	:	US
Telephone Number	:	770-818-9859
Fax Number	:	770-850-0832

Authorized Official
Title or Position	:	CEO
Name	:	WAYNE J GUIDETTI
Credential	:
Telephone Number	:	469-499-2857

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	09/14/2009

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