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General NPI Number Information
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NPI Number | 1174572374
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Entity Type | Organization
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Legal Business Name | SUMMIT RADIOLOGY SERVICES PC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 12/15/2021
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Provider Practice Location Address
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Address Line | 17 JACKSON PL NW
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City | CARTERSVILLE
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State | GA
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Zip | 30121-6080
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Country | US
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Telephone | 770-607-7339
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Fax | 678-928-9759
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Provider Business Mailing Address
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Address Line | PO BOX 200096
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City | CARTERSVILLE
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State | GA
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Zip | 30120-9002
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Country | US
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Telephone | 770-607-7339
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Fax | 678-928-9759
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. MINH LE
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Credential |
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Telephone | 404-312-3129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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