Healthcare Provider Details

I. General information

NPI: 1710552435
Provider Name (Legal Business Name): ADVANCED DIAGNOSTIC IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BLVD STE 220
SMYRNA TN
37167-6800
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-391-4545
  • Fax: 615-391-4546
Mailing address:
  • Phone: 615-239-2018
  • Fax: 615-851-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN FENTON
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 615-854-3409