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General NPI Number Information
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NPI Number | 1205393444
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Entity Type | Organization
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Legal Business Name | ADVANCED DIAGNOSTIC IMAGING, PC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 150 SAM WALTON DR STE 300
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City | SPARTA
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State | TN
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Zip | 38583-8813
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Country | US
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Telephone | 931-738-4060
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Fax | 931-738-4064
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Provider Business Mailing Address
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Address Line | 3024 BUSINESS PARK CIR
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City | GOODLETTSVILLE
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State | TN
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Zip | 37072-3132
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Country | US
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Telephone | 615-851-6033
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | SUSAN FENTON
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Credential |
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Telephone | 615-851-6033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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