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General NPI Number Information
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NPI Number | 1629032149
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Entity Type | Organization
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Legal Business Name | SLEEP LABS OF THE DEEP SOUTH LLC
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 13702 COURSEY BOULEVARD BUILDING 4 SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70817-1370
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Country | US
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Telephone | 225-925-3357
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Fax | 225-924-9863
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Provider Business Mailing Address
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Address Line | 382 B CARRIAGE HOUSE DRIVE
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City | JACKSON
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State | TN
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Zip | 38305-2299
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Country | US
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Telephone | 731-664-8716
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Fax | 731-664-8932
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. REBECCA ESTELLE GAYLORD
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Credential |
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Telephone | 225-925-3357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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