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General NPI Number Information
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NPI Number | 1699957787
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Entity Type | Organization
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Legal Business Name | ONE SOURCE DIAGNOSTICS, INC.
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 3314 16TH AVE SE SUITE 201
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City | CONOVER
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State | NC
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Zip | 28613-9694
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Country | US
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Telephone | 704-325-0810
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Fax | 704-325-0812
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Provider Business Mailing Address
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Address Line | 3314 16TH AVE SE SUITE 201
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City | CONOVER
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State | NC
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Zip | 28613-9694
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Country | US
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Telephone | 704-325-0810
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Fax | 704-325-0812
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRADY LEE WHITE
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Credential | RRT-RCP
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Telephone | 828-781-7413
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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 | A-559
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License Number State | NC
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