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General NPI Number Information
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NPI Number | 1356324487
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Entity Type | Organization
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Legal Business Name | GASTON RADIOLOGY PA
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 620 SUMMIT CROSSING PL STE 106
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City | GASTONIA
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State | NC
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Zip | 28054-2176
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Country | US
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Telephone | 704-867-8021
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Fax | 704-864-4606
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Provider Business Mailing Address
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Address Line | PO BOX 745431
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City | ATLANTA
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State | GA
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Zip | 30374-5431
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Country | US
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Telephone | 843-449-5360
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Fax | 706-653-4711
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ERIC JAX
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Credential |
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Telephone | 704-867-8021
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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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