Healthcare Provider Details

I. General information

NPI: 1487680732
Provider Name (Legal Business Name): SOUTHERN TENNESSEE RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HOSPITAL RD
WINCHESTER TN
37398
US

IV. Provider business mailing address

PO BOX 2125
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 866-457-9896
  • Fax: 706-226-2283
Mailing address:
  • Phone: 866-457-9896
  • Fax: 706-226-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL D ELLIS
Title or Position: OWNER
Credential: MD
Phone: 866-457-9896