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General NPI Number Information
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NPI Number | 1255619441
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Entity Type | Organization
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Legal Business Name | DIGITAL MAMMOGRAPHY SPECIALISTS - CONYERS, LLC
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 3242 AVALON BLVD.
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City | CONYERS
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State | GA
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Zip | 30013
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Country | US
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Telephone | 678-904-6823
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Fax | 678-904-6824
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Provider Business Mailing Address
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Address Line | 3242 AVALON BLVD
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City | CONYERS
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State | GA
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Zip | 30013-6320
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Country | US
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Telephone | 678-904-6823
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Fax | 770-679-1425
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Authorized Official
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Title or Position | CEO
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Name | DR. MANJU MORRISSEY
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Credential | M.D.
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Telephone | 866-917-2806
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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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