Healthcare Provider Details

I. General information

NPI: 1952470999
Provider Name (Legal Business Name): ATLANTIC RADIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEST STREET
ROSEBORO NC
28382
US

IV. Provider business mailing address

PO BOX 30367 DEPT 208
CHARLOTTE NC
28230-0367
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-3731
  • Fax:
Mailing address:
  • Phone: 910-525-3731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE W EASON
Title or Position: PRESIDENT
Credential: MD
Phone: 910-525-3731