1164197273 NPI number — ADVANCED DIAGNOSTIC IMAGING, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164197273 NPI number — ADVANCED DIAGNOSTIC IMAGING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED DIAGNOSTIC IMAGING, 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:
1164197273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3024 BUSINESS PARK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-239-2018
Provider Business Mailing Address Fax Number:
629-208-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7116 NOLENSVILLE RD STE 704
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOLENSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37135-2983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-283-9903
Provider Business Practice Location Address Fax Number:
615-283-8148
Provider Enumeration Date:
08/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FENTON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
615-854-3409

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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