Healthcare Provider Details

I. General information

NPI: 1346206539
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211A W MEDICAL PARK DR
AUGUSTA GA
30909-4504
US

IV. Provider business mailing address

1211A W MEDICAL PARK DR
AUGUSTA GA
30909-4504
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-2603
  • Fax: 706-364-2606
Mailing address:
  • Phone: 706-364-2603
  • Fax: 706-364-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM R MACDONALD
Title or Position: CEO
Credential: RN
Phone: 706-364-2603