Healthcare Provider Details

I. General information

NPI: 1699860130
Provider Name (Legal Business Name): ELITE MRI OF LAURENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 FAIRVIEW PARK DRIVE #A
DUBLIN GA
31021
US

IV. Provider business mailing address

P.O. BOX 4003
MACON GA
31208
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-8895
  • Fax: 478-275-8896
Mailing address:
  • Phone: 478-755-9966
  • Fax: 478-755-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER O HOLLIDAY III
Title or Position: DIRECTOR
Credential: M.D.
Phone: 478-275-8895