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General NPI Number Information
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NPI Number | 1295038180
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Entity Type | Organization
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Legal Business Name | STATE OF THE ART IMAGING
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 3586 KILLARNEY TRL
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City | SNELLVILLE
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State | GA
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Zip | 30039-5964
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Country | US
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Telephone | 678-630-7947
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Fax |
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Provider Business Mailing Address
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Address Line | 3586 KILLARNEY TRL
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City | SNELLVILLE
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State | GA
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Zip | 30039-5964
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Country | US
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Telephone | 678-630-7947
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. DONALD JAMES MINOTT
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Credential | RADIOLOGICAL TECH
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Telephone | 770-896-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 331540
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License Number State | GA
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