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General NPI Number Information
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NPI Number | 1265899959
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Entity Type | Organization
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Legal Business Name | DELTA SLEEP CENTER PLLC
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 11/13/2018
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Provider Practice Location Address
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Address Line | 1505 WOODLAWN AVE STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-3145
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Country | US
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Telephone | 731-676-2894
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Fax | 731-334-5608
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Provider Business Mailing Address
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Address Line | 204 ROELLEN RD
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City | NEWBERN
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State | TN
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Zip | 38059-4079
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Country | US
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Telephone | 731-676-2894
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MAHINDER P S TALWAR
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Credential | RPSGT
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Telephone | 731-676-2894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 21677
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License Number State | TN
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