Healthcare Provider Details

I. General information

NPI: 1487285193
Provider Name (Legal Business Name): AU HEALTH IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3722 WHEELER RD
AUGUSTA GA
30909-6638
US

IV. Provider business mailing address

1120 15TH ST # BI1056
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-8623
  • Fax: 706-721-1439
Mailing address:
  • Phone: 706-721-3813
  • Fax: 706-721-9286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: AMY STOUT
Title or Position: PRESIDENT/CEO
Credential:
Phone: 615-261-2306