Healthcare Provider Details

I. General information

NPI: 1568651644
Provider Name (Legal Business Name): DIGITAL MAMMOGRAPHY SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ARIZONA AVENUE NE SUITE 200
ATLANTA GA
30307-2299
US

IV. Provider business mailing address

200 ARIZONA AVENUE NE SUITE 200
ATLANTA GA
30307-2299
US

V. Phone/Fax

Practice location:
  • Phone: 404-207-1768
  • Fax: 678-904-6824
Mailing address:
  • Phone: 404-207-1768
  • Fax: 678-904-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. MANJU R. MORRISSEY
Title or Position: CEO
Credential: MD
Phone: 404-207-1768