# INNOVATIVE SLEEP DIAGNOSTICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205026499
- **Authorized official:** MR. JIMMIE ROYCE DAUGHERTY II (PRESIDENT)
- **Authorized official phone:** (423) 764-4480

## Contact information

- **Practice address:** 1104 TUSCULUM BLVD, STE 301, GREENEVILLE, TN 37745-4091
- **Practice address phone:** (423) 764-1579
- **Mailing address:** 105 MEADOWVIEW RD, STE 2, BRISTOL, TN 37620-1725
- **Mailing address phone:** (423) 764-4480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1200X | Sleep Disorder Diagnostic Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/25/2007
- **Last updated:** 10/18/2007