MEDICARE: DIAGNOSTIC HEALTH CORPORATION

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1457300832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC HEALTH CORPORATION

Provider Business Mailing Address
First Line	:	225 MEDICAL WAY
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2522
Country	:	US
Telephone Number	:	770-991-6747
Fax Number	:	770-907-7801

Provider Business Practice Location Address
First Line	:	225 MEDICAL WAY
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2522
Country	:	US
Telephone Number	:	770-991-6747
Fax Number	:	770-907-7801

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	DONNA L BURCH
Credential	:
Telephone Number	:	866-685-5001

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	08/22/2020

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Directions to “DIAGNOSTIC HEALTH CORPORATION ” Practice Location

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