1518190685 NPI number — OPEN MRI OF GEORGIA, LLC

Table of content: (NPI 1518190685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518190685 NPI number — OPEN MRI OF GEORGIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPEN MRI OF GEORGIA, LLC
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:
MIDTOWN DIAGNOSTIC IMAGING
Provider Other Organization Name Type Code:
3
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:
1518190685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 932391
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-2391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-393-5600
Provider Business Mailing Address Fax Number:
770-300-9018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WEST PEACHTREE ST NW
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-875-2640
Provider Business Practice Location Address Fax Number:
404-874-6752
Provider Enumeration Date:
08/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
770-300-0101

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)





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