Healthcare Provider Details

I. General information

NPI: 1164670667
Provider Name (Legal Business Name): HOME CARE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 SHERWOOD FOREST DR
DOUGLASVILLE GA
30134-5808
US

IV. Provider business mailing address

187 SHERWOOD FOREST DR
DOUGLASVILLE GA
30134-5808
US

V. Phone/Fax

Practice location:
  • Phone: 678-668-3101
  • Fax: 404-696-1997
Mailing address:
  • Phone: 678-668-3101
  • Fax: 404-696-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number326204
License Number StateGA

VIII. Authorized Official

Name: AMIRA KARRIEM
Title or Position: CEO
Credential: RT(R)(M) ARRT
Phone: 678-668-3101