Healthcare Provider Details

I. General information

NPI: 1235078296
Provider Name (Legal Business Name): FLOURISH IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 WINDWARD LN STE 3
GAINESVILLE GA
30501-7418
US

IV. Provider business mailing address

2022 WINDWARD LN STE 3
GAINESVILLE GA
30501-7418
US

V. Phone/Fax

Practice location:
  • Phone: 770-272-0705
  • Fax: 770-272-0704
Mailing address:
  • Phone: 770-272-0705
  • Fax: 770-272-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GREG BORDELON
Title or Position: VICE PRESIDENT
Credential:
Phone: 318-321-9185