MEDICARE: ULTRASOUND SERVICES OF GEORGIA 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	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1831413210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRASOUND SERVICES OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	533 MERRILL LANE
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-5612
Country	:	US
Telephone Number	:	770-631-8034
Fax Number	:	770-631-8034

Provider Business Practice Location Address
First Line	:	533 MERRILL LANE
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-5612
Country	:	US
Telephone Number	:	770-631-8034
Fax Number	:	770-631-8034

Authorized Official
Title or Position	:	MEMBER/MANAGER
Name	:	MR. RASHMIKANT KANUBHAI PATEL
Credential	:	RCS, RVS
Telephone Number	:	770-631-8034

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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