Healthcare Provider Details

I. General information

NPI: 1548567654
Provider Name (Legal Business Name): DIAGNOSTICS IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2011
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6584 PROFESSIONAL PL SUITE D
RIVERDALE GA
30274-4942
US

IV. Provider business mailing address

PO BOX 405052
ATLANTA GA
30384-5052
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-6001
  • Fax: 770-991-6002
Mailing address:
  • Phone: 678-802-1464
  • Fax: 678-802-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. THOMAS W BROWN
Title or Position: PRESIDENT
Credential:
Phone: 678-802-1464