MEDICARE: PRESGAR IMAGING OF AUGUSTA, 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619199932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESGAR IMAGING OF AUGUSTA, LLC

Provider Business Mailing Address
First Line	:	23110 STATE RD 54
Second Line	:	PMB 292
City	:	LUTZ
State	:	FL
Zip	:	33549
Country	:	US
Telephone Number	:	352-578-2055
Fax Number	:	813-977-0143

Provider Business Practice Location Address
First Line	:	3610 WHEELER ROAD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909
Country	:	US
Telephone Number	:	706-210-9500
Fax Number	:	706-210-9600

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MR. ROBBIE ROBERTSON
Credential	:
Telephone Number	:	813-323-2594

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	10/28/2021

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