Provider Demographics
NPI:1902134786
Name:NATIONAL SLEEP DIAGNOSTICS
Entity Type:Organization
Organization Name:NATIONAL SLEEP DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:678-736-6604
Mailing Address - Street 1:1600 ATKINSON RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5602
Mailing Address - Country:US
Mailing Address - Phone:678-736-6604
Mailing Address - Fax:
Practice Address - Street 1:1600 ATKINSON RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5602
Practice Address - Country:US
Practice Address - Phone:678-736-6604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1004261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic