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General NPI Number Information
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NPI Number | 1235224346
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Entity Type | Organization
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Legal Business Name | SOUTHERN RADIOLOGY SERVICES
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 606 ACADEMY AVENUE
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City | DUBLIN
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State | GA
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Zip | 31021
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Country | US
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Telephone | 478-274-1100
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Fax | 478-274-1166
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Provider Business Mailing Address
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Address Line | P. O. BOX 1527
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City | DUBLIN
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State | GA
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Zip | 31040
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Country | US
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Telephone | 478-274-1100
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Fax | 478-274-1166
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RAGAHAVA A BHASKARAN
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Credential | M.D.
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Telephone | 478-274-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 025580
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 025580
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number | 025580
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 025580
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License Number State | GA
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