Healthcare Provider Details

I. General information

NPI: 1447901889
Provider Name (Legal Business Name): PROVIDENCE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 BASS RD STE 102
MACON GA
31210-1098
US

IV. Provider business mailing address

5016 NELLY LN
TALLAHASSEE FL
32303-8284
US

V. Phone/Fax

Practice location:
  • Phone: 478-259-6051
  • Fax: 478-259-2124
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONYA STOKES
Title or Position: CEO
Credential:
Phone: 850-562-1656