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General NPI Number Information
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NPI Number | 1932155355
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Entity Type | Organization
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Legal Business Name | IMAGING ASSOCIATES OF CANTON
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 200 OAKSIDE LN SUITE A
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City | CANTON
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State | GA
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Zip | 30114-6415
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Country | US
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Telephone | 770-479-1945
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Fax | 770-479-1948
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Provider Business Mailing Address
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Address Line | 200 OAKSIDE LN SUITE A
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City | CANTON
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State | GA
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Zip | 30114-6415
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Country | US
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Telephone | 770-479-1945
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Fax | 770-479-1948
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Authorized Official
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Title or Position | PRESIDENT / MEDICAL DIRECTOR
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Name | DR. BRADLEY ROBERT PETERS
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Credential | M.D.
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Telephone | 770-479-1945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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