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General NPI Number Information
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NPI Number | 1932786449
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Entity Type | Organization
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Legal Business Name | OSSP IMAGING OF LOUISVILLE
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 03/29/2021
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Provider Practice Location Address
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Address Line | 801 BARRET AVE STE 104
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City | LOUISVILLE
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State | KY
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Zip | 40204-1732
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Country | US
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Telephone | 502-371-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 5788 ROSWELL RD
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City | ATLANTA
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State | GA
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Zip | 30328-4904
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Country | US
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Telephone | 305-290-2448
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | RA'KESHIA BROGDON
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Credential |
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Telephone | 404-941-1233
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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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