Healthcare Provider Details

I. General information

NPI: 1326099748
Provider Name (Legal Business Name): ALBANY DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 DAWSON RD
ALBANY GA
31707-1609
US

IV. Provider business mailing address

1069 BAXTER STREET SUITE C
ATHENS GA
30606
US

V. Phone/Fax

Practice location:
  • Phone: 229-888-1624
  • Fax: 229-888-1457
Mailing address:
  • Phone: 706-354-1036
  • Fax: 706-354-0529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD L. GRAY
Title or Position: OWNER/CEO
Credential:
Phone: 706-354-1036