Healthcare Provider Details

I. General information

NPI: 1780676601
Provider Name (Legal Business Name): MRI OF ANDALUSIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 E THREE NOTCH ST
ANDALUSIA AL
36421-2403
US

IV. Provider business mailing address

1823 E THREE NOTCH ST
ANDALUSIA AL
36421-2403
US

V. Phone/Fax

Practice location:
  • Phone: 334-427-7222
  • Fax: 334-427-7223
Mailing address:
  • Phone: 334-427-7222
  • Fax: 334-427-7223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES W. HOLMES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 337-291-9161