Healthcare Provider Details

I. General information

NPI: 1457870099
Provider Name (Legal Business Name): DYNAMIC XRAY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 11/19/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 OAKVIEW DR STE 400
POWDER SPRINGS GA
30127-2233
US

IV. Provider business mailing address

3855 OAKVIEW DR STE 400
POWDER SPRINGS GA
30127-2233
US

V. Phone/Fax

Practice location:
  • Phone: 678-698-5725
  • Fax:
Mailing address:
  • Phone: 678-698-5725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH DURU
Title or Position: OWNER
Credential: BS,RT(R)CNMT
Phone: 678-698-5725