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General NPI Number Information
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NPI Number | 1871407064
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Entity Type | Organization
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Legal Business Name | GEORGIA BREAST RADIOLOGY SPECIALISTS LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 105 GRAND CENTRAL BLVD STE 106
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City | POOLER
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State | GA
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Zip | 31322-4148
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Country | US
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Telephone | 866-717-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 15601 DALLAS PKWY STE 300
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City | ADDISON
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State | TX
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Zip | 75001-6012
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Country | US
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Telephone | 866-717-2551
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MICHAEL J DELEO III
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Credential | MD
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Telephone | 610-745-4400
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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 |
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License Number State | NULL
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