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General NPI Number Information
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NPI Number | 1679294227
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Entity Type | Organization
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Legal Business Name | BCA GEORGIA, LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 1850 N COLUMBIA ST STE 3
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7113
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Country | US
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Telephone | 478-453-4101
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1067
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City | STATESBORO
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State | GA
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Zip | 30459-1067
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Country | US
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Telephone | 912-764-2455
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Fax | 912-764-7522
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Authorized Official
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Title or Position | CEO
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Name | DR. GARY HARPER DENT
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Credential | MD
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Telephone | 912-764-2455
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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 |
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