Healthcare Provider Details

I. General information

NPI: 1679709224
Provider Name (Legal Business Name): JOHNS CREEK DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 MCGINNIS FERRY RD STE 300
SUWANEE GA
30024-6673
US

IV. Provider business mailing address

PO BOX 933556
ATLANTA GA
31193-3556
US

V. Phone/Fax

Practice location:
  • Phone: 678-835-2299
  • Fax: 678-835-2296
Mailing address:
  • Phone: 678-835-2299
  • Fax: 678-835-2296

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: PAUL COTE
Title or Position: COO
Credential:
Phone: 706-256-3450