MEDICARE: ATHENA MEDICAL IMAGING, 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	261QR0208X	Mobile Radiology Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1902359854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENA MEDICAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	11770 HAYNES BRIDGE RD STE 205-530
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-1966
Country	:	US
Telephone Number	:	866-300-8512
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 DEPUTY BILL CANTRELL MEM STE 205
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-3069
Country	:	US
Telephone Number	:	866-300-8512
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RAJASHAKHER P. REDDY
Credential	:	MD
Telephone Number	:	404-345-8000

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	02/02/2026

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