Healthcare Provider Details

I. General information

NPI: 1598081093
Provider Name (Legal Business Name): COLUMBUS DIAGNOSTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 VETERANS PKWY STE B
COLUMBUS GA
31909-2525
US

IV. Provider business mailing address

PO BOX 931077
ATLANTA GA
31193-1077
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-7622
  • Fax: 706-256-3454
Mailing address:
  • Phone: 706-256-3450
  • Fax: 706-256-3454

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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

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