Provider Demographics
NPI:1417342973
Name:SLEEP DISORDERS OF TENNESSEE
Entity Type:Organization
Organization Name:SLEEP DISORDERS OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER- MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-746-1471
Mailing Address - Street 1:254 REN MAR DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3723
Mailing Address - Country:US
Mailing Address - Phone:615-746-1471
Mailing Address - Fax:615-746-4536
Practice Address - Street 1:254 REN MAR DR STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3723
Practice Address - Country:US
Practice Address - Phone:615-746-1471
Practice Address - Fax:615-746-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000648758261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty