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NPI Code Detail

MEDICARE: NORTHWEST DIAGNOSTIC IMAGING, INC

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
12085R0202XDiagnostic Radiology PhysicianGA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DA0357OTHERGARAILROAD MEDICARE
2CH7800OTHERGARAILROAD MEDICARE
4CA0798OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3226870814OTHERGAUS DEPARTMENT OF LABOR

General Provider Information

NPI Number : 1225019730
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 : 100 MOUNTAIN VIEW DR
Second Line : SUITE 200
City : CUMMING
State : GA
Zip : 30040-2434
Country : US
Telephone Number : 770-205-8800
Fax Number : 770-205-1966
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 : 09/02/2010

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