Healthcare Provider Details

I. General information

NPI: 1023066313
Provider Name (Legal Business Name): DIAGNOSTIC HEALTH CORPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 CENTRAL AVE
AUGUSTA GA
30904-6704
US

IV. Provider business mailing address

2102 CENTRAL AVE
AUGUSTA GA
30904-6704
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0551
  • Fax: 706-733-1343
Mailing address:
  • Phone: 706-733-0551
  • Fax: 706-733-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DONNA L BURCH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 205-685-5075