MEDICARE: NORTHWEST DIAGNOSTIC IMAGING, 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		GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA0357	OTHER	GA	RAILROAD MEDICARE
3	CA0798	OTHER	GA	RAILROAD MEDICARE
4	CH7800	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	226870823	OTHER	GA	US DEPARTMENT OF LABOR

General Provider Information

NPI Number	:	1114908621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST DIAGNOSTIC IMAGING, 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	:	600 PROFESSIONAL DR
Second Line	:	SUITE 100
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7651
Country	:	US
Telephone Number	:	770-963-4445
Fax Number	:	770-963-5285

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/20/2008

Similar Medicare Providers

1699769703 — GASTROINTESTINAL ENDOSCOPY OF GWINNETT, P.C.
Practice Location Address:

600 PROFESSIONAL DR , STE 130
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 770-995-7989
Practice Fax: 770-339-8646

1467446559 — DR. ANDREW LOUIS SEIBERT M.D.
Practice Location Address:

600 PROFESSIONAL DR , STE 140
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 770-995-7989
Practice Fax: 770-277-2930

1720036957 — CYNTHIA LAWRENCE ELLIOTT M.D.
Practice Location Address:

600 PROFESSIONAL DR , SUITE 260
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 770-822-1090
Practice Fax: 770-513-9735

1386672723 — KATHERINE RENEE WILSON NP
Practice Location Address:

600 PROFESSIONAL DR , SUITE 210
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 770-963-8030
Practice Fax: 770-339-8086

1659303808 — HOWARD C GOLDBERG MD
Practice Location Address:

600 PROFESSIONAL DR , SUITE 120
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 770-963-8444
Practice Fax: 770-963-2261

1487664405 — MRS. MEGHAN LYNN SUMMERALL P.A.
Practice Location Address:

600 PROFESSIONAL DR
LAWRENCEVILLE, GA
30045-7651

Practice Phone: 678-312-3317
Practice Fax:

Directions to “NORTHWEST DIAGNOSTIC IMAGING, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.