Healthcare Provider Details

I. General information

NPI: 1821318452
Provider Name (Legal Business Name): GEORGIA SLEEP AND NEURODIAGNOSTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 06/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 LANDING PT
STOCKBRIDGE GA
30281-9066
US

IV. Provider business mailing address

1022 LANDING PT
STOCKBRIDGE GA
30281-9066
US

V. Phone/Fax

Practice location:
  • Phone: 404-952-9443
  • Fax:
Mailing address:
  • Phone: 404-952-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. ANDRE LOTUS MORISSETTE
Title or Position: CEO/
Credential: ND,
Phone: 404-952-9443