Healthcare Provider Details

I. General information

NPI: 1629032149
Provider Name (Legal Business Name): SLEEP LABS OF THE DEEP SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13702 COURSEY BOULEVARD BUILDING 4 SUITE A
BATON ROUGE LA
70817-1370
US

IV. Provider business mailing address

382 B CARRIAGE HOUSE DRIVE
JACKSON TN
38305-2299
US

V. Phone/Fax

Practice location:
  • Phone: 225-925-3357
  • Fax: 225-924-9863
Mailing address:
  • Phone: 731-664-8716
  • Fax: 731-664-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. REBECCA ESTELLE GAYLORD
Title or Position: OFFICE MANAGER
Credential:
Phone: 225-925-3357