Healthcare Provider Details

I. General information

NPI: 1548457062
Provider Name (Legal Business Name): GEORGIA ULTRASOUND, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 MCGINNIS PARK DR SUITE #1
SUWANEE GA
30024-7136
US

IV. Provider business mailing address

3620 MCGINNIS PARK DR SUITE #1
SUWANEE GA
30024-7136
US

V. Phone/Fax

Practice location:
  • Phone: 770-932-8599
  • Fax: 678-730-1013
Mailing address:
  • Phone: 770-932-8599
  • Fax: 678-730-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberGA031432
License Number StateGA

VIII. Authorized Official

Name: MR. ALLEN TRADER
Title or Position: MANAGER
Credential:
Phone: 770-932-8599