Healthcare Provider Details

I. General information

NPI: 1902359854
Provider Name (Legal Business Name): ATHENA MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEPUTY BILL CANTRELL MEM STE 205
CUMMING GA
30040-3069
US

IV. Provider business mailing address

11770 HAYNES BRIDGE RD STE 205-530
ALPHARETTA GA
30009-1966
US

V. Phone/Fax

Practice location:
  • Phone: 866-300-8512
  • Fax:
Mailing address:
  • Phone: 866-300-8512
  • Fax:

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 Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAJASHAKHER P. REDDY
Title or Position: MANAGER
Credential: MD
Phone: 404-345-8000