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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
1CH7800OTHERGARAILROAD MEDICARE
2CA0798OTHERGARAILROAD MEDICARE
4DA0357OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
322687080OTHERGAUS DEPARTMENT OF LABOR

General Provider Information

NPI Number : 1265413025
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 : 535 N CENTRAL AVE
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1603
Country : US
Telephone Number : 404-684-1011
Fax Number : 404-684-8210
Authorized Official
Title or Position : COO
Name : MR. DANIEL J SCHAEFER
Credential :
Telephone Number : 770-300-0101
Provider Enumeration Date : 11/09/2005
Last Update Date : 05/20/2008

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Directions to “NORTHWEST DIAGNOSTIC IMAGING, INC ” Practice Location

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