Provider Demographics
NPI:1073804241
Name:SLEEP UNLIMITED JACKSON
Entity Type:Organization
Organization Name:SLEEP UNLIMITED JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHOMY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:EALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-758-2838
Mailing Address - Street 1:764 WALNUT KNOLL LN
Mailing Address - Street 2:STE 200
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3113
Mailing Address - Country:US
Mailing Address - Phone:901-758-2838
Mailing Address - Fax:901-758-2479
Practice Address - Street 1:101 CLINICAL CENTRE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305
Practice Address - Country:US
Practice Address - Phone:901-758-2838
Practice Address - Fax:901-758-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic