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General NPI Number Information
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NPI Number | 1023410842
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Entity Type | Organization
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Legal Business Name | THE PINK RIBBON MAMMOGRAPHY AND DIAGNOSTIC RADIOLOGY SERVICES LLC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 07/13/2023
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Provider Practice Location Address
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Address Line | 256 VALLEY VIEW CIR
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City | DALLAS
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State | GA
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Zip | 30132-9806
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Country | US
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Telephone | 678-903-5786
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Fax | 888-545-1070
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Provider Business Mailing Address
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Address Line | 256 VALLEY VIEW CIR
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City | DALLAS
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State | GA
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Zip | 30132-9806
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Country | US
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Telephone | 678-903-5786
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Fax | 888-545-1070
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Authorized Official
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Title or Position | CEO
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Name | MRS. AMIRA KARRIEM
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Credential | BS RT R, M, CT
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Telephone | 678-903-5798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 326204
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License Number State | GA
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