Healthcare Provider Details

I. General information

NPI: 1255619441
Provider Name (Legal Business Name): DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3242 AVALON BLVD.
CONYERS GA
30013
US

IV. Provider business mailing address

3242 AVALON BLVD
CONYERS GA
30013-6320
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-6823
  • Fax: 678-904-6824
Mailing address:
  • Phone: 678-904-6823
  • Fax: 770-679-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MANJU MORRISSEY
Title or Position: CEO
Credential: M.D.
Phone: 866-917-2806