Healthcare Provider Details

I. General information

NPI: 1184650228
Provider Name (Legal Business Name): MARSHALL RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 US HIGHWAY 431
BOAZ AL
35957-5908
US

IV. Provider business mailing address

PO BOX 1164
DALTON GA
30722-1164
US

V. Phone/Fax

Practice location:
  • Phone: 256-840-3688
  • Fax:
Mailing address:
  • Phone: 706-271-0100
  • Fax: 706-270-0487

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: DR. LISA DRISKILL
Title or Position: PRESIDENT
Credential: MD
Phone: 706-271-0100