Healthcare Provider Details

I. General information

NPI: 1225044068
Provider Name (Legal Business Name): JOHN CREEK DIAGNOSTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 MCGINNIS FERRY RD SUITE 300
SUWANEE GA
30024-6672
US

IV. Provider business mailing address

PO BOX 933556
ATLANTA GA
31193-3556
US

V. Phone/Fax

Practice location:
  • Phone: 678-835-2299
  • Fax: 706-256-3454
Mailing address:
  • Phone: 706-256-3450
  • Fax: 706-256-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: TRACI BROWN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 705-256-3450