MEDICARE: DIAGNOSTIC IMAGING, 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	:	1346206539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC IMAGING, LLC

Provider Business Mailing Address
First Line	:	1211A W MEDICAL PARK DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4504
Country	:	US
Telephone Number	:	706-364-2603
Fax Number	:	706-364-2606

Provider Business Practice Location Address
First Line	:	1211A W MEDICAL PARK DR
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-4504
Country	:	US
Telephone Number	:	706-364-2603
Fax Number	:	706-364-2606

Authorized Official
Title or Position	:	CEO
Name	:	WILLIAM R MACDONALD
Credential	:	RN
Telephone Number	:	706-364-2603

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/22/2020

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Directions to “DIAGNOSTIC IMAGING, LLC ” Practice Location

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