Healthcare Provider Details

I. General information

NPI: 1083383327
Provider Name (Legal Business Name): INOVASLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2537
US

IV. Provider business mailing address

2566 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2537
US

V. Phone/Fax

Practice location:
  • Phone: 678-522-3635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA HERINGTON
Title or Position: OWNER
Credential: DDS
Phone: 678-522-3635