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General NPI Number Information
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NPI Number | 1417458233
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Entity Type | Organization
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Legal Business Name | PROCARE ULTRASOUND
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 4500 SATELLITE BLVD STE 2190
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City | DULUTH
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State | GA
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Zip | 30096-8850
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Country | US
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Telephone | 404-507-6797
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 SATELLITE BLVD STE 2190
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City | DULUTH
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State | GA
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Zip | 30096-8850
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Country | US
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Telephone | 404-507-6797
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Fax |
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Authorized Official
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Title or Position | ULTRASOUND TECH
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Name | HONG HUONG PHAM
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Credential | ARDMS
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Telephone | 404-507-6797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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