Healthcare Provider Details

I. General information

NPI: 1316108624
Provider Name (Legal Business Name): COLUMBUS DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/21/2022
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 10TH AVE
COLUMBUS GA
31901-1461
US

IV. Provider business mailing address

PO BOX 931077
ATLANTA GA
31193-1077
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-3000
  • Fax: 706-256-3454
Mailing address:
  • Phone: 706-322-3000
  • Fax: 706-256-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOE PAUL
Title or Position: PRESIDENT
Credential:
Phone: 561-744-9122