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NPI Code Detail

MEDICARE: ALBANY DIAGNOSTIC CENTER, LLC

MEDICARE: ALBANY DIAGNOSTIC CENTER, 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
1261QR0200XRadiology Clinic/Center
2261QM1200XMagnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number : 1326099748
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBANY DIAGNOSTIC CENTER, LLC
Provider Business Mailing Address
First Line : 1069 BAXTER STREET
Second Line : SUITE C
City : ATHENS
State : GA
Zip : 30606
Country : US
Telephone Number : 706-354-1036
Fax Number : 706-354-0529
Provider Business Practice Location Address
First Line : 2624 DAWSON RD
Second Line :
City : ALBANY
State : GA
Zip : 31707-1609
Country : US
Telephone Number : 229-888-1624
Fax Number : 229-888-1457
Authorized Official
Title or Position : OWNER/CEO
Name : MR. RICHARD L. GRAY
Credential :
Telephone Number : 706-354-1036
Provider Enumeration Date : 05/12/2006
Last Update Date : 04/05/2010

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Directions to “ALBANY DIAGNOSTIC CENTER, LLC ” Practice Location

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