MEDICARE: LUXURY SLEEP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	11086172	GA

General Provider Information

NPI Number	:	1821362351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUXURY SLEEP, LLC

Provider Business Mailing Address
First Line	:	1833 PEACHTREE RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1524
Country	:	US
Telephone Number	:	404-748-1927
Fax Number	:	404-748-9513

Provider Business Practice Location Address
First Line	:	1833 PEACHTREE RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1524
Country	:	US
Telephone Number	:	404-748-1927
Fax Number	:	404-748-9513

Authorized Official
Title or Position	:	CEO
Name	:	MISS MALINDA WALLER
Credential	:	B.S. IN BIOLOGY
Telephone Number	:	404-748-1927

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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