Healthcare Provider Details

I. General information

NPI: 1326029828
Provider Name (Legal Business Name): NORTHWEST DIAGNOSTIC IMAGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 COBB GALLERIA PKWY SUITE 120
ATLANTA GA
30339-5927
US

IV. Provider business mailing address

PO BOX 932391
ATLANTA GA
31193-2391
US

V. Phone/Fax

Practice location:
  • Phone: 770-933-1963
  • Fax: 770-933-0763
Mailing address:
  • Phone: 678-393-5600
  • Fax: 770-300-9018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. DANIEL J SCHAEFER
Title or Position: COO
Credential:
Phone: 770-300-0101