Healthcare Provider Details

I. General information

NPI: 1073561478
Provider Name (Legal Business Name): NATIONAL IMAGING AFFILIATES OF FAYETTEVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 VILLAGE DR
FAYETTEVILLE NC
28304-3865
US

IV. Provider business mailing address

2764 PELHAM PKWY
PELHAM AL
35124-1702
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-2209
  • Fax: 910-323-2209
Mailing address:
  • Phone: 205-685-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERI MILLER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 205-685-5000