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General NPI Number Information
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NPI Number | 1518586825
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Entity Type | Organization
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Legal Business Name | EMSITE LLC
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 4275 JOHNS CREEK PKWY SUITE C
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City | SUWANEE
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State | GA
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Zip | 30024-9117
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Country | US
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Telephone | 678-807-8627
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Fax | 770-234-6650
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Provider Business Mailing Address
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Address Line | 4275 JOHNS CREEK PKWY STE C
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City | SUWANEE
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State | GA
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Zip | 30024-9117
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Country | US
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Telephone | 678-807-8627
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. YVENER LIBERAL
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Credential |
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Telephone | 678-807-8627
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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