Healthcare Provider Details

I. General information

NPI: 1326396029
Provider Name (Legal Business Name): TENNESSEE SLEEP MANAGMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 STONEBRIDGE BLVD STE C
JACKSON TN
38305-2038
US

IV. Provider business mailing address

104 STONEBRIDGE BLVD
JACKSON TN
38305-2038
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-4121
  • Fax:
Mailing address:
  • Phone: 731-882-1938
  • Fax:

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: DEBBIE MILLS
Title or Position: OWNER
Credential: CRT PSGT
Phone: 731-882-1938