Healthcare Provider Details

I. General information

NPI: 1225252091
Provider Name (Legal Business Name): TENNESSEE IMAGING ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 HATCHER LN
COLUMBIA TN
38401-3535
US

IV. Provider business mailing address

1405 HATCHER LN
COLUMBIA TN
38401-3535
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-2848
  • Fax: 931-388-2858
Mailing address:
  • Phone: 931-388-2848
  • Fax: 931-388-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE DOUGLAS
Title or Position: CONTRACT MANAGER
Credential:
Phone: 502-477-1815