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General NPI Number Information
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NPI Number | 1548567654
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Entity Type | Organization
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Legal Business Name | DIAGNOSTICS IMAGING SERVICES
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 6584 PROFESSIONAL PL SUITE D
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City | RIVERDALE
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State | GA
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Zip | 30274-4942
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Country | US
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Telephone | 770-991-6001
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Fax | 770-991-6002
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Provider Business Mailing Address
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Address Line | PO BOX 405052
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City | ATLANTA
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State | GA
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Zip | 30384-5052
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Country | US
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Telephone | 678-802-1464
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Fax | 678-802-0271
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS W BROWN
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Credential |
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Telephone | 678-802-1464
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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 |
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License Number State | GA
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