1316020464 NPI number — RHEA RADIOLOGY, PC

Table of content: (NPI 1316020464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316020464 NPI number — RHEA RADIOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RHEA RADIOLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316020464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30162-6067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-291-8257
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 RHEA COUNTY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37321-5912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-775-1121
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAVIDOFF
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-559-8620

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)