Provider Demographics
NPI:1912056193
Name:TULLAHOMA SLEEP DISORDER CENTER
Entity Type:Organization
Organization Name:TULLAHOMA SLEEP DISORDER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-454-2242
Mailing Address - Street 1:928 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2332
Mailing Address - Country:US
Mailing Address - Phone:931-454-2242
Mailing Address - Fax:931-454-1217
Practice Address - Street 1:928 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2332
Practice Address - Country:US
Practice Address - Phone:931-454-2242
Practice Address - Fax:931-454-1217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG34269Medicare UPIN
TN3717552Medicare ID - Type Unspecified