Healthcare Provider Details

I. General information

NPI: 1528013968
Provider Name (Legal Business Name): GREGORY H DODSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIGNATURE PL STE 102
LEBANON TN
37087-3377
US

IV. Provider business mailing address

PO BOX 1211
LEBANON TN
37088-1211
US

V. Phone/Fax

Practice location:
  • Phone: 615-453-6228
  • Fax: 615-453-6230
Mailing address:
  • Phone:
  • 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: GREGORY H DODSON
Title or Position: PRESIDENT
Credential:
Phone: 615-453-6228