Healthcare Provider Details

I. General information

NPI: 1679400311
Provider Name (Legal Business Name): ATLANTIC DIAGNOSTIC CENTER LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 1ST ST
MACON GA
31201-2825
US

IV. Provider business mailing address

555 1ST ST
MACON GA
31201-2825
US

V. Phone/Fax

Practice location:
  • Phone: 478-744-0758
  • Fax: 478-744-9552
Mailing address:
  • Phone: 478-744-0759
  • Fax: 478-744-9552

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: IYABO MURAINA
Title or Position: BUSINESS MANAGER
Credential:
Phone: 478-744-9603