Healthcare Provider Details

I. General information

NPI: 1902554033
Provider Name (Legal Business Name): ELITE SLEEP PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 FIELD ST
BREMEN GA
30110-2048
US

IV. Provider business mailing address

211 FIELD ST
BREMEN GA
30110-2048
US

V. Phone/Fax

Practice location:
  • Phone: 770-538-1624
  • Fax: 770-299-4349
Mailing address:
  • Phone: 770-538-1624
  • Fax: 770-299-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TINA GARRETT
Title or Position: CEO
Credential: BS, RPSGT, RST, CCSH
Phone: 770-538-1624