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General NPI Number Information
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NPI Number | 1407237449
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Entity Type | Organization
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Legal Business Name | SHYNE LITE IMAGING SOLUTIONS LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/16/2015
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Provider Practice Location Address
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Address Line | 714 PEACHTREE STATION CIR
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2959
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Country | US
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Telephone | 646-260-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 714 PEACHTREE STATION CIR
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2959
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Country | US
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Telephone | 646-260-3011
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. JOSCLYN J SPICER
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Credential | BS, DMS
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Telephone | 646-260-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 15033127
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License Number State | GA
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