Healthcare Provider Details

I. General information

NPI: 1881302495
Provider Name (Legal Business Name): JEANINE IMAGING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SANDSTONE DR
HAMPTON GA
30228-5543
US

IV. Provider business mailing address

203 SANDSTONE DR
HAMPTON GA
30228-5543
US

V. Phone/Fax

Practice location:
  • Phone: 470-497-8399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDE DIJUSTE
Title or Position: CEO/ PRESIDENT
Credential:
Phone: 470-497-8399