MEDICARE: CHATTAHOOCHEE SLEEP CENTER LLC

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	:	1932423191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHATTAHOOCHEE SLEEP CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 397
Second Line	:
City	:	MIDLAND
State	:	GA
Zip	:	31820-0397
Country	:	US
Telephone Number	:	706-221-7256
Fax Number	:	706-221-7254

Provider Business Practice Location Address
First Line	:	2410 DOUBLE CHURCHES RD
Second Line	:	STE B
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2741
Country	:	US
Telephone Number	:	706-221-7256
Fax Number	:	706-221-7254

Authorized Official
Title or Position	:	PARTNER
Name	:	BRYANT HOUSTON
Credential	:
Telephone Number	:	706-563-1478

Provider Enumeration Date	:	03/17/2010
Last Update Date	:	03/03/2012

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