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General NPI Number Information
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NPI Number | 1093142101
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Entity Type | Organization
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Legal Business Name | BABY DIMENSIONS
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 20 BAKER RD STE 9
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City | NEWNAN
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State | GA
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Zip | 30265-2134
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Country | US
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Telephone | 770-502-0225
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BAKER RD STE 9
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City | NEWNAN
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State | GA
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Zip | 30265-2134
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Country | US
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Telephone | 770-502-0225
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Fax |
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Authorized Official
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Title or Position | SONOGRAPHER
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Name | MISS STACEY LANETTE LIVINGSTON
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Credential | ARDMS
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Telephone | 770-502-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 45982
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License Number State | GA
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