MEDICARE: TELEMAMMOGRAPHY SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	41663	TN

General Provider Information

NPI Number	:	1245514363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELEMAMMOGRAPHY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 201
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-987-9287
Fax Number	:	404-404-8945

Provider Business Practice Location Address
First Line	:	125 E TRINITY PL
Second Line	:	SUITE 201
City	:	DECATUR
State	:	GA
Zip	:	30030-3360
Country	:	US
Telephone Number	:	404-987-9287
Fax Number	:	404-404-8945

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTHA HOEL GARRISON
Credential	:	MD
Telephone Number	:	404-987-9287

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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