1548567654 NPI number — DIAGNOSTICS IMAGING SERVICES

Table of content: (NPI 1548567654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548567654 NPI number — DIAGNOSTICS IMAGING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTICS IMAGING 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:
1548567654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 405052
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-5052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-802-1464
Provider Business Mailing Address Fax Number:
678-802-0271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6584 PROFESSIONAL PL
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30274-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-991-6001
Provider Business Practice Location Address Fax Number:
770-991-6002
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-802-1464

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com