Healthcare Provider Details

I. General information

NPI: 1306096755
Provider Name (Legal Business Name): IMAGING ASSOCIATES OF NORTH GEORGIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N BROAD ST
WINDER GA
30680-2150
US

IV. Provider business mailing address

PO BOX 465448
LAWRENCEVILLE GA
30042-5448
US

V. Phone/Fax

Practice location:
  • Phone: 770-867-3400
  • Fax:
Mailing address:
  • Phone: 770-688-3804
  • Fax: 770-237-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number019496
License Number StateGA

VIII. Authorized Official

Name: DAVID A CAUSEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-561-5404