Provider Demographics
NPI:1144398082
Name:AZALEA SLEEP LABS, INC.
Entity Type:Organization
Organization Name:AZALEA SLEEP LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:229-563-8576
Mailing Address - Street 1:2935 N ASHLEY ST
Mailing Address - Street 2:STE 124
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1777
Mailing Address - Country:US
Mailing Address - Phone:229-333-7601
Mailing Address - Fax:229-333-7602
Practice Address - Street 1:2935 N ASHLEY ST
Practice Address - Street 2:STE 124
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1777
Practice Address - Country:US
Practice Address - Phone:229-333-7601
Practice Address - Fax:229-333-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory