Healthcare Provider Details

I. General information

NPI: 1639364458
Provider Name (Legal Business Name): PEACEFUL SLEEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HIGHWAY 278 E SUITE C
AMORY MS
38821-4339
US

IV. Provider business mailing address

304 HIGHWAY 278 E SUITE C
AMORY MS
38821-4339
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-8222
  • Fax: 662-256-7088
Mailing address:
  • Phone: 662-256-8222
  • Fax: 662-256-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. BRADLEY MICHAEL CORBELL
Title or Position: MANAGER
Credential:
Phone: 662-256-8222