Healthcare Provider Details

I. General information

NPI: 1396779567
Provider Name (Legal Business Name): AMERICAN SLEEP DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WILLOW CREEK DR
LONG BEACH MS
39560-3311
US

IV. Provider business mailing address

PO BOX 660
LONG BEACH MS
39560-0660
US

V. Phone/Fax

Practice location:
  • Phone: 228-865-3998
  • Fax: 228-865-1665
Mailing address:
  • Phone: 228-865-3998
  • Fax: 228-865-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LAWRENCE JASPER GRAVES
Title or Position: MANAGING PARTNER
Credential: DDS
Phone: 228-897-1636