1386609303 NPI number — DIAGNOSTIC IMAGING SOLUTIONS

Table of content: (NPI 1386609303)

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".




Copyright © 2007-2025 www.npivalidator.com