Healthcare Provider Details

I. General information

NPI: 1215268446
Provider Name (Legal Business Name): CAHABA VALLEY IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RACQUET CLUB LANE
PELHAM AL
35124
US

IV. Provider business mailing address

502 MONTGOMERY HWY SUITE 101
VESTAVIA HILLS AL
35216-1862
US

V. Phone/Fax

Practice location:
  • Phone: 205-418-1212
  • Fax: 205-418-1214
Mailing address:
  • Phone: 205-418-1212
  • Fax: 205-418-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number17189
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number17189
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number17189
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number17189
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number17189
License Number StateAL
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number17189
License Number StateAL

VIII. Authorized Official

Name: DR. CHARLES MICHAEL MEAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 205-823-0882