Healthcare Provider Details

I. General information

NPI: 1700199940
Provider Name (Legal Business Name): GRIFFIN IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ROCK STREET
GRIFFIN GA
30224
US

IV. Provider business mailing address

PO BOX 931477
ATLANTA GA
31193-1477
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-4660
  • Fax: 770-229-4632
Mailing address:
  • Phone: 770-229-4660
  • Fax: 770-229-4632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACI L BROWN
Title or Position: DIRECTOR OF BILLING
Credential: MBA
Phone: 706-256-3450