Healthcare Provider Details

I. General information

NPI: 1902518236
Provider Name (Legal Business Name): SOUTHERN RADIOLOGY GROUPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

7801 OLD BRANCH AVE STE 202
CLINTON MD
20735-1642
US

V. Phone/Fax

Practice location:
  • Phone: 202-221-8442
  • Fax: 202-221-8443
Mailing address:
  • Phone: 202-221-8442
  • Fax: 202-221-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONTOYA SUMMERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-523-6595