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General NPI Number Information
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NPI Number | 1548457062
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Entity Type | Organization
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Legal Business Name | GEORGIA ULTRASOUND, L.L.C.
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Dates
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Enumeration Date | 09/28/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 3620 MCGINNIS PARK DR SUITE #1
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City | SUWANEE
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State | GA
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Zip | 30024-7136
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Country | US
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Telephone | 770-932-8599
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Fax | 678-730-1013
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Provider Business Mailing Address
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Address Line | 3620 MCGINNIS PARK DR SUITE #1
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City | SUWANEE
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State | GA
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Zip | 30024-7136
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Country | US
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Telephone | 770-932-8599
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Fax | 678-730-1013
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ALLEN TRADER
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Credential |
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Telephone | 770-932-8599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | GA031432
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License Number State | GA
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