Healthcare Provider Details

I. General information

NPI: 1417342973
Provider Name (Legal Business Name): SLEEP DISORDERS OF TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 REN MAR DR STE 200
PLEASANT VIEW TN
37146-3723
US

IV. Provider business mailing address

254 REN MAR DR STE 200
PLEASANT VIEW TN
37146-3723
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-1471
  • Fax: 615-746-4536
Mailing address:
  • Phone: 615-746-1471
  • Fax: 615-746-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number000648758
License Number StateTN

VIII. Authorized Official

Name: DR. MARTHA HAGAMAN
Title or Position: PART OWNER- MEDICAL DOCTOR
Credential: M.D
Phone: 615-746-1471