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General NPI Number Information
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NPI Number | 1356572796
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Entity Type | Organization
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Legal Business Name | 3D IMAGING CSRA, LLC
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Dates
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Enumeration Date | 08/03/2009
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Last Update Date | 08/03/2009
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Provider Practice Location Address
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Address Line | 584 BLUE RIDGE DR
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City | EVANS
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State | GA
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Zip | 30809-3604
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Country | US
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Telephone | 706-589-6556
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Fax |
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Provider Business Mailing Address
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Address Line | 584 BLUE RIDGE DR
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City | EVANS
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State | GA
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Zip | 30809-3604
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Country | US
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Telephone | 706-589-6556
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MS. LISA T DUNN
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Credential |
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Telephone | 706-589-6556
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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 | 31122008
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License Number State | GA
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