1346371531 NPI number — INDEPENDENT DIAGNOSTIC SERVICES

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 1346371531 NPI number — INDEPENDENT DIAGNOSTIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDEPENDENT DIAGNOSTIC SERVICES
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:
6
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:
1346371531
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:
1296 SIMS ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30501-3850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-297-1700
Provider Business Mailing Address Fax Number:
770-297-1702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 PEACHTREE STREET
Provider Second Line Business Practice Location Address:
SUITE 1760
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-817-0734
Provider Business Practice Location Address Fax Number:
404-817-0737
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONSOLA
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
AR DIRECTOR
Authorized Official Telephone Number:
770-297-1700

Provider Taxonomy Codes

  • Taxonomy code: 247100000X , with the licence number:  199912 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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