Healthcare Provider Details

I. General information

NPI: 1790300838
Provider Name (Legal Business Name): WOMEN'S IMAGING SPECIALISTS - FAIRHOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 CIPRIANO CT STE A
FAIRHOPE AL
36532-3029
US

IV. Provider business mailing address

3180 N POINT PKWY STE 106
ALPHARETTA GA
30005-4349
US

V. Phone/Fax

Practice location:
  • Phone: 866-300-8512
  • Fax: 800-613-8386
Mailing address:
  • Phone: 866-300-8512
  • Fax: 800-613-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L REDDY
Title or Position: MANAGER
Credential:
Phone: 866-300-8512