Healthcare Provider Details

I. General information

NPI: 1437107638
Provider Name (Legal Business Name): HIALEAH M R I INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CROWN POINTE PKWY SUITE 295
ATLANTA GA
30338-7707
US

IV. Provider business mailing address

1050 CROWN POINTE PKWY SUITE 295
ATLANTA GA
30338-7707
US

V. Phone/Fax

Practice location:
  • Phone: 866-325-5434
  • Fax: 866-325-5340
Mailing address:
  • Phone: 866-325-5434
  • Fax: 866-325-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STEVEN SHAPIRO
Title or Position: OWNER
Credential:
Phone: 866-325-5434