MEDICARE: AMERICAN HEALTH IMAGING OF GEORGIA 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1114902053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN HEALTH IMAGING OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 745973
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-5973
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 E WEST CONNECTOR
Second Line	:	SUITE 122
City	:	AUSTELL
State	:	GA
Zip	:	30106-6848
Country	:	US
Telephone Number	:	770-739-9770
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	KATRINA ROELLE
Credential	:
Telephone Number	:	614-689-1691

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/18/2024

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