=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285847905
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL SLEEP DIAGNOSITCS OF GEORGIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 HURRICANE SHOALS RD NE BLDG B-800
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-4826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-237-8440
-----------------------------------------------------
Fax | 770-237-9268
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 SAINT ANN DR
-----------------------------------------------------
City | MANDEVILLE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70471-3265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-626-6211
-----------------------------------------------------
Fax | 985-626-6227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AR DIRECTOR
-----------------------------------------------------
Name | BETSY RIVAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-626-6211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247200000X
-----------------------------------------------------
Taxonomy Name | Other Technician
-----------------------------------------------------
License Number | 2006018928
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------