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General NPI Number Information
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NPI Number | 1629221510
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING OF ALABAMA LLC
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1699 GOLDEN SPRINGS RD
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City | ANNISTON
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State | AL
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Zip | 36207-7097
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Country | US
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Telephone | 256-835-0835
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Fax | 256-549-0401
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Provider Business Mailing Address
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Address Line | 820 SOUTH 4TH STREET
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City | GADSDEN
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State | AL
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Zip | 35901-5223
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Country | US
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Telephone | 256-549-0008
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Fax | 256-549-0401
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. KENNON H HAGER
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Credential | MD
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Telephone | 256-549-0008
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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 | 17729
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License Number State | AL
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