MEDICARE: OPEN MRI OF GEORGIA, INC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1104059138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN MRI OF GEORGIA, INC

Provider Business Mailing Address
First Line	:	PO BOX 932391
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-2391
Country	:	US
Telephone Number	:	678-393-5600
Fax Number	:	770-300-9018

Provider Business Practice Location Address
First Line	:	300 PARKBROOKE PL
Second Line	:	SUITE 170
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-7209
Country	:	US
Telephone Number	:	678-494-2345
Fax Number	:	678-494-2420

Authorized Official
Title or Position	:	C.O.O.
Name	:	MR. DANIEL J SCHAEFER
Credential	:
Telephone Number	:	770-300-0101

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	09/23/2013

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