MEDICARE: AMERICAN HEALTH IMAGING OF GA 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1447802780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH IMAGING OF GA LLC

Provider Business Mailing Address
First Line	:	2200 CENTURY PKWY NE STE 600
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3116
Country	:	US
Telephone Number	:	404-297-5207
Fax Number	:	404-478-8944

Provider Business Practice Location Address
First Line	:	2851 WASHINGTON RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-2131
Country	:	US
Telephone Number	:	404-297-5207
Fax Number	:

Authorized Official
Title or Position	:	MANAGED CARE DIRECTOR
Name	:	MELISSA CHARVAT
Credential	:
Telephone Number	:	404-297-5207

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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