Provider Demographics
NPI:1821318452
Name:GEORGIA SLEEP AND NEURODIAGNOSTIC
Entity Type:Organization
Organization Name:GEORGIA SLEEP AND NEURODIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:LOTUS
Authorized Official - Last Name:MORISSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:ND,
Authorized Official - Phone:404-952-9443
Mailing Address - Street 1:1022 LANDING PT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9066
Mailing Address - Country:US
Mailing Address - Phone:404-952-9443
Mailing Address - Fax:
Practice Address - Street 1:1022 LANDING PT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9066
Practice Address - Country:US
Practice Address - Phone:404-952-9443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-05
Last Update Date:2010-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QS1200X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic