Healthcare Provider Details

I. General information

NPI: 1033896667
Provider Name (Legal Business Name): TBI DIAGNOSTIC CENTERS OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SCRANTON RD
CLEVELAND OH
44113-4313
US

IV. Provider business mailing address

3535 PEACHTREE RD NE STE 320
ATLANTA GA
30326-3395
US

V. Phone/Fax

Practice location:
  • Phone: 833-883-8378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GAIRY JOHNSON
Title or Position: MANAGING MEMBER
Credential:
Phone: 301-213-9915