Organization
MADISON SLEEP LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROLAND B WALL III (MANAGER)
(601) 932-3397
Entity
Organization
Contact information
Practice address
1883 HIGHWAY 43 S, CANTON, MS 39046-8405
(601) 859-0730
(601) 859-0731
Mailing address
199 INTERSTATE DR, STE C, RICHLAND, MS 39218-4428
(601) 932-3397
(601) 932-3398
Taxonomy
Speciality
Code
Description
License number
State
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
03/20/2008
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