Healthcare Provider Details

I. General information

NPI: 1700121837
Provider Name (Legal Business Name): PCTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CARROLL CT
NORCROSS GA
30071-5010
US

IV. Provider business mailing address

1004 CARROLL CT
NORCROSS GA
30071-5010
US

V. Phone/Fax

Practice location:
  • Phone: 404-547-7483
  • Fax:
Mailing address:
  • Phone: 404-547-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number07505
License Number StateGA

VIII. Authorized Official

Name: YURIY ALEX ARANBAYEV
Title or Position: RT(R)
Credential:
Phone: 404-547-7483