Healthcare Provider Details

I. General information

NPI: 1225376866
Provider Name (Legal Business Name): RIVERSIDE IMAGING SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 RIVERSIDE DR SUITE B
MACON GA
31204-1747
US

IV. Provider business mailing address

2140 RIVERSIDE DR SUITE B
MACON GA
31204-1747
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-6747
  • Fax: 478-745-6749
Mailing address:
  • Phone: 478-745-6747
  • Fax: 478-745-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOWARD JONES WILLIAMS III
Title or Position: OWNER
Credential: M.D.
Phone: 478-745-6747