Healthcare Provider Details

I. General information

NPI: 1265350409
Provider Name (Legal Business Name): ELITE DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 EAGLES NEST CIR
DECATUR GA
30035-2234
US

IV. Provider business mailing address

2236 EAGLES NEST CIR
DECATUR GA
30035-2234
US

V. Phone/Fax

Practice location:
  • Phone: 404-287-4510
  • Fax:
Mailing address:
  • Phone: 404-287-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ZETHERY AUNDRA REED
Title or Position: CEO
Credential: ARRT
Phone: 404-287-4510