Healthcare Provider Details

I. General information

NPI: 1922757111
Provider Name (Legal Business Name): DX MSO OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W WALNUT AVE STE 1
DALTON GA
30720-3827
US

IV. Provider business mailing address

1025 PEERLESS XING NW
CLEVELAND TN
37312-3764
US

V. Phone/Fax

Practice location:
  • Phone: 423-476-5990
  • Fax: 423-476-5887
Mailing address:
  • Phone: 423-476-5990
  • Fax: 423-476-5887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES TODD RUDOLPH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 423-322-5050