Healthcare Provider Details

I. General information

NPI: 1477704831
Provider Name (Legal Business Name): SOUTH ATLANTA RADIOLOGY ASSOCIATES- GRIFFIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680A S 9TH ST
GRIFFIN GA
30224-4216
US

IV. Provider business mailing address

PO BOX 2963
KENNESAW GA
30156-9117
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-7625
  • Fax:
Mailing address:
  • Phone: 770-779-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S BROWNSEY II
Title or Position: PRACTICE MANAGER
Credential:
Phone: 423-322-2194