Healthcare Provider Details

I. General information

NPI: 1497700496
Provider Name (Legal Business Name): SOUTHERN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PENNINGTON DR
BLUFFTON SC
29910-6036
US

IV. Provider business mailing address

PO BOX 8007
HILTON HEAD ISLAND SC
29938-8007
US

V. Phone/Fax

Practice location:
  • Phone: 843-815-4600
  • Fax:
Mailing address:
  • Phone: 843-815-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS JENKINS
Title or Position: MANAGER
Credential:
Phone: 843-815-4600