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General NPI Number Information
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NPI Number | 1881639516
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Entity Type | Organization
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Legal Business Name | MOBILE IMAGING GROUP, P.C.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 2726 E LAMAR ALEXANDER PKWY
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City | MARYVILLE
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State | TN
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Zip | 37804-3539
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Country | US
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Telephone | 865-981-3391
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Fax | 865-982-5185
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Provider Business Mailing Address
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Address Line | PO BOX 5870
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City | MARYVILLE
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State | TN
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Zip | 37802-5870
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Country | US
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Telephone | 865-981-3391
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Fax | 865-982-5185
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. FREDDIE JAMES BENNETT
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Credential | MD
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Telephone | 865-981-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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