MEDICARE: DIAGNOSTICS IMAGING SERVICES

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		GA

General Provider Information

NPI Number	:	1548567654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTICS IMAGING SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 405052
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-5052
Country	:	US
Telephone Number	:	678-802-1464
Fax Number	:	678-802-0271

Provider Business Practice Location Address
First Line	:	6584 PROFESSIONAL PL
Second Line	:	SUITE D
City	:	RIVERDALE
State	:	GA
Zip	:	30274-4942
Country	:	US
Telephone Number	:	770-991-6001
Fax Number	:	770-991-6002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS W BROWN
Credential	:
Telephone Number	:	678-802-1464

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	02/25/2011

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Directions to “DIAGNOSTICS IMAGING SERVICES ” Practice Location

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