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General NPI Number Information
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NPI Number | 1124299490
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Entity Type | Organization
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Legal Business Name | DYSPHAGIA MOBILE IMAGING, INC.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 2315 CENTRAL AVE STE C
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City | AUGUSTA
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State | GA
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Zip | 30904-6246
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Country | US
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Telephone | 706-496-2161
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Fax | 866-902-8686
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Provider Business Mailing Address
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Address Line | 2315 CENTRAL AVE STE C
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City | AUGUSTA
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State | GA
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Zip | 30904-6246
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Country | US
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Telephone | 706-496-2161
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Fax | 866-902-8686
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Authorized Official
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Title or Position | PRESIDENT
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Name | GORDON JONES
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Credential | DHA
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Telephone | 706-496-2161
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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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