Provider Demographics
NPI:1528127586
Name:ATLANTIC SLEEP LAB, INC.
Entity type:Organization
Organization Name:ATLANTIC SLEEP LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOOKMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLAGUNJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-744-9603
Mailing Address - Street 1:P O BOX 24299
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208
Mailing Address - Country:US
Mailing Address - Phone:478-744-9603
Mailing Address - Fax:478-744-9552
Practice Address - Street 1:560 FIRST STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-744-9603
Practice Address - Fax:478-744-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory