Healthcare Provider Details

I. General information

NPI: 1528582947
Provider Name (Legal Business Name): PEACEFUL SLUMBER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 HOSPITAL DR
COLUMBUS MS
39705-1920
US

IV. Provider business mailing address

323 HOSPITAL DR
COLUMBUS MS
39705-1920
US

V. Phone/Fax

Practice location:
  • Phone: 662-323-3833
  • Fax: 662-328-3275
Mailing address:
  • Phone: 662-323-3833
  • Fax: 662-328-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number3039-98
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3039-98
License Number StateMS

VIII. Authorized Official

Name: KATHERINE ANN GRAY
Title or Position: OWNER
Credential: DMD
Phone: 662-328-3833