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General NPI Number Information
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NPI Number | 1871665463
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Entity Type | Organization
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Legal Business Name | ADVANCED SLEEP LABORATORY - ALPHARETTA LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 960 JOHNSON FERRY RD NE SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30342-1631
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Country | US
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Telephone | 404-705-0855
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Fax |
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Provider Business Mailing Address
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Address Line | 11815 NORTHFALL LN SUITE 1002
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City | ALPHARETTA
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State | GA
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Zip | 30009-7973
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Country | US
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Telephone | 404-705-0855
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SAMUEL A MICKELSON
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Credential | MD
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Telephone | 404-705-0855
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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 | 7198
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License Number State | GA
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