=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043418304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE HEALTH DIAGNOSTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2007
-----------------------------------------------------
Last Update Date | 10/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 WESTSIDE PKWY SUITE 210
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-4994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-777-1868
-----------------------------------------------------
Fax | 770-777-1872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 WESTSIDE PKWY SUITE 210
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-4994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-777-1868
-----------------------------------------------------
Fax | 770-777-1872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | SCOTT HUNTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-777-1868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------