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General NPI Number Information
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NPI Number | 1396825741
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Entity Type | Organization
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Legal Business Name | OPEN MRI OF DOUGLAS LLC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 1315 OCILLA ROAD
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City | DOUGLAS
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State | GA
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Zip | 31533
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Country | US
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Telephone | 912-393-1144
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Fax | 912-393-1124
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Provider Business Mailing Address
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Address Line | 1103 FOUNTAIN LAKE DR
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City | BRUNSWICK
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State | GA
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Zip | 31525-3039
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Country | US
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Telephone | 912-267-6736
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Fax | 912-262-1922
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Authorized Official
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Title or Position | ACCOUNT DIRECTOR
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Name | MS. CAROLINE HARRIS
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Credential |
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Telephone | 912-267-6736
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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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