1922193044 NPI number — NORTH GEORGIA RADIOLOGY

Table of content: (NPI 1922193044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922193044 NPI number — NORTH GEORGIA RADIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH GEORGIA RADIOLOGY
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:
1922193044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2546
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30722-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-271-0100
Provider Business Mailing Address Fax Number:
706-270-0487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 N THORNTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30720-3093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-259-4428
Provider Business Practice Location Address Fax Number:
706-226-2283
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MORRISON
Authorized Official First Name:
RACHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
423-310-1642

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000315774B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB4606 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".