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General NPI Number Information
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NPI Number | 1174785240
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Entity Type | Organization
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Legal Business Name | DIGITAL MAMMOGRAPHY SPECIALISTS-EAGLES LANDING, LLC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 115 EAGLE SPRING DR SUITE 100
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6486
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Country | US
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Telephone | 678-904-7209
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Fax | 770-507-5199
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Provider Business Mailing Address
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Address Line | 200 ARIZONA AVE NE SUITE 200
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City | ATLANTA
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State | GA
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Zip | 30307-2299
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Country | US
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Telephone | 678-904-6820
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Fax | 678-904-6824
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MANJU R. MORRISSEY
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Credential | M.D.
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Telephone | 678-904-6820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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