1891737490 NPI number — EAST COBB MRI CENTER

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 1891737490 NPI number — EAST COBB MRI CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COBB MRI CENTER
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:
1891737490
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:
4205 N POINT PKWY
Provider Second Line Business Mailing Address:
BUILDING D
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30022-8808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-619-2767
Provider Business Mailing Address Fax Number:
770-619-2760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1197 JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-971-7284
Provider Business Practice Location Address Fax Number:
770-619-2760
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSING
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-619-2767

Provider Taxonomy Codes

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

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





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