1700912532 NPI number — GEORGIA HEALTH IMAGING

Table of content: (NPI 1700912532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700912532 NPI number — GEORGIA HEALTH IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA HEALTH IMAGING
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:
1700912532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3653 LAWRENCEVILLE HWY
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30044-4107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-924-0964
Provider Business Mailing Address Fax Number:
678-924-0965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3653 LAWRENCEVILLE HWY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30044-4107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-924-0964
Provider Business Practice Location Address Fax Number:
678-924-0965
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUDHWANI
Authorized Official First Name:
YASMIN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
678-924-0964

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; 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: 000502796N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRP8122 . This is a "PTAN #" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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