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General NPI Number Information
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NPI Number | 1700121837
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Entity Type | Organization
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Legal Business Name | PCTI
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Dates
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Enumeration Date | 11/29/2012
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Last Update Date | 11/29/2012
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Provider Practice Location Address
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Address Line | 1004 CARROLL CT
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City | NORCROSS
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State | GA
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Zip | 30071-5010
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Country | US
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Telephone | 404-547-7483
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 CARROLL CT
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City | NORCROSS
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State | GA
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Zip | 30071-5010
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Country | US
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Telephone | 404-547-7483
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Fax |
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Authorized Official
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Title or Position | RT(R)
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Name | YURIY ALEX ARANBAYEV
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Credential |
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Telephone | 404-547-7483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 07505
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License Number State | GA
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