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General NPI Number Information
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NPI Number | 1225376866
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Entity Type | Organization
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Legal Business Name | RIVERSIDE IMAGING SPECIALISTS, LLC
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 08/27/2014
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Provider Practice Location Address
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Address Line | 2140 RIVERSIDE DR SUITE B
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City | MACON
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State | GA
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Zip | 31204-1747
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Country | US
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Telephone | 478-745-6747
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Fax | 478-745-6749
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Provider Business Mailing Address
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Address Line | 2140 RIVERSIDE DR SUITE B
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City | MACON
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State | GA
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Zip | 31204-1747
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Country | US
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Telephone | 478-745-6747
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Fax | 478-745-6749
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Authorized Official
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Title or Position | OWNER
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Name | HOWARD JONES WILLIAMS III
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Credential | M.D.
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Telephone | 478-745-6747
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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