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General NPI Number Information
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NPI Number | 1821341272
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Entity Type | Organization
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Legal Business Name | COMMERCE RADIOLOGY, LLC
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 70 MEDICAL CENTER DR
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City | COMMERCE
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State | GA
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Zip | 30529-1078
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Country | US
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Telephone | 706-335-1420
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Fax | 864-223-1396
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Provider Business Mailing Address
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Address Line | 108 VENTURE CT
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City | GREENWOOD
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State | SC
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Zip | 29649-8558
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Country | US
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Telephone | 864-223-3070
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Fax | 864-223-1396
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Authorized Official
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Title or Position | OWNER
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Name | THAD DEWARD LONG
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Credential | MD
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Telephone | 678-469-0007
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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 | 020769
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License Number State | GA
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