Healthcare Provider Details

I. General information

NPI: 1578536686
Provider Name (Legal Business Name): DCA DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 CRESTMARK DR SUITE 102
LITHIA SPRINGS GA
30122-2646
US

IV. Provider business mailing address

880 CRESTMARK DR STE 102
LITHIA SPRINGS GA
30122-2646
US

V. Phone/Fax

Practice location:
  • Phone: 678-388-2040
  • Fax: 678-388-2031
Mailing address:
  • Phone: 678-741-2317
  • Fax: 770-944-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number048324
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY L JONES
Title or Position: PRACTICE ADMINISTRATION
Credential:
Phone: 678-741-2317