Healthcare Provider Details

I. General information

NPI: 1417458233
Provider Name (Legal Business Name): PROCARE ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SATELLITE BLVD STE 2190
DULUTH GA
30096-8850
US

IV. Provider business mailing address

4500 SATELLITE BLVD STE 2190
DULUTH GA
30096-8850
US

V. Phone/Fax

Practice location:
  • Phone: 404-507-6797
  • Fax:
Mailing address:
  • Phone: 404-507-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: HONG HUONG PHAM
Title or Position: ULTRASOUND TECH
Credential: ARDMS
Phone: 404-507-6797