Healthcare Provider Details

I. General information

NPI: 1396683421
Provider Name (Legal Business Name): DIVINE IMAGING ATL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 GROVE PLACE XING SW
LILBURN GA
30047-8601
US

IV. Provider business mailing address

5775 GROVE PLACE XING SW
LILBURN GA
30047-8601
US

V. Phone/Fax

Practice location:
  • Phone: 470-404-6286
  • Fax:
Mailing address:
  • Phone: 470-404-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JASPINDER SINGH
Title or Position: CO-OWNER
Credential:
Phone: 404-519-2852