MEDICARE: OPEN MRI OF DECATUR LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033179809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF DECATUR LLC

Provider Business Mailing Address
First Line	:	PO BOX 4003
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31208-4003
Country	:	US
Telephone Number	:	478-314-5002
Fax Number	:	478-755-9964

Provider Business Practice Location Address
First Line	:	1201 13TH AVE SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4301
Country	:	US
Telephone Number	:	256-350-7779
Fax Number	:	256-350-2272

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. PETER O HOLLIDAY III
Credential	:
Telephone Number	:	478-314-5009

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	02/24/2026

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