Provider Demographics
NPI:1689958803
Name:ADVANCED CENTER FOR SLEEP DISORDERS
Entity Type:Organization
Organization Name:ADVANCED CENTER FOR SLEEP DISORDERS
Other - Org Name:CENTER FOR FAMILY MEDICINE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANUJ
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-648-8008
Mailing Address - Street 1:6073 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3909
Mailing Address - Country:US
Mailing Address - Phone:423-648-8008
Mailing Address - Fax:706-657-4400
Practice Address - Street 1:1411 CHATTANOOGA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2673
Practice Address - Country:US
Practice Address - Phone:423-648-8008
Practice Address - Fax:706-657-4400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CENTER FOR SLEEP DISORDERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-06
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA248184207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty