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General NPI Number Information
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NPI Number | 1326650136
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Entity Type | Organization
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Legal Business Name | TBI DIAGNOSTIC CENTERS OF GEORGIA
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 4294 MEMORIAL DR STE D
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City | DECATUR
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State | GA
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Zip | 30032-1226
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Country | US
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Telephone | 678-203-8802
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Fax |
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Provider Business Mailing Address
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Address Line | 100 QUIVAS CT SW
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City | ATLANTA
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State | GA
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Zip | 30331-7524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | GAIRY JOHNSON
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Credential |
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Telephone | 678-203-8802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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