=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447326178
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGH FIELD OPEN MRI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10630 ALPHARETTA WAY
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-649-8500
-----------------------------------------------------
Fax | 770-649-8591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10630 ALPHARETTA WAY
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-649-8500
-----------------------------------------------------
Fax | 770-649-8591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONAL MANAGER PARTNER
-----------------------------------------------------
Name | MR. RAJIV GOSWAMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-649-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 00680
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------