Healthcare Provider Details

I. General information

NPI: 1457553968
Provider Name (Legal Business Name): GAINESVILLE IMAGING ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 JESSE JEWELL PKWY SE STE. 500
GAINESVILLE GA
30501-3871
US

IV. Provider business mailing address

PO BOX 2438
GAINESVILLE GA
30503-2438
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-9936
  • Fax: 770-534-9877
Mailing address:
  • Phone: 770-532-9936
  • Fax: 770-534-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number033142
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number033142
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085H0002X
TaxonomyHospice and Palliative Medicine (Radiology) Physician
License Number033142
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number033142
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number033142
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number033142
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number033142
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number033142
License Number StateGA

VIII. Authorized Official

Name: JEFF N MCINTIRE
Title or Position: PRESIDENT
Credential:
Phone: 770-532-9936