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General NPI Number Information
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NPI Number | 1679380034
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Entity Type | Organization
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Legal Business Name | J&JIMAGING
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 804 COMMERCE BLVD STE A10
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City | RIVERDALE
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State | GA
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Zip | 30296-7193
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Country | US
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Telephone | 816-646-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 LYONS WALK
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City | ELLENWOOD
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State | GA
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Zip | 30294-1622
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Country | US
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Telephone | 816-646-9965
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DARNITA JACKSON
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Credential | RVT
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Telephone | 404-668-6588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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