MEDICARE: COLUMBUS DIAGNOSTIC CENTER 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	261QR0200X	Radiology Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician		GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GRP2151	OTHER	GA	MEDICARE PTAN

General Provider Information

NPI Number	:	1316108624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS DIAGNOSTIC CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 931077
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1077
Country	:	US
Telephone Number	:	706-322-3000
Fax Number	:	706-256-3454

Provider Business Practice Location Address
First Line	:	2040 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1461
Country	:	US
Telephone Number	:	706-322-3000
Fax Number	:	706-256-3454

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOE PAUL
Credential	:
Telephone Number	:	561-744-9122

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	07/21/2022

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