1386609303 NPI number — DIAGNOSTIC IMAGING SOLUTIONS

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 1386609303 NPI number — DIAGNOSTIC IMAGING SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC IMAGING SOLUTIONS
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:
1386609303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2140 BUFORD HWY
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
BUFORD
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30518-6120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-546-5000
Provider Business Mailing Address Fax Number:
678-546-0055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2140 BUFORD HWY
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BUFORD
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30518-6120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-546-5000
Provider Business Practice Location Address Fax Number:
678-546-0055
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LATTIMER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
678-546-5000

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000710091Q , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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