Provider Demographics
NPI:1831465400
Name:SPECIALIZED SLEEP DIAGNOSTIC
Entity Type:Organization
Organization Name:SPECIALIZED SLEEP DIAGNOSTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-607-8570
Mailing Address - Street 1:29 PEACHTREE CIR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3518
Mailing Address - Country:US
Mailing Address - Phone:404-607-8570
Mailing Address - Fax:404-815-9282
Practice Address - Street 1:29 PEACHTREE CIR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3518
Practice Address - Country:US
Practice Address - Phone:404-607-8570
Practice Address - Fax:404-815-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26474173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000207248BMedicaid
GA000207248BMedicaid