MEDICARE: SHYNE LITE IMAGING SOLUTIONS 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	15033127	GA

General Provider Information

NPI Number	:	1407237449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHYNE LITE IMAGING SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	714 PEACHTREE STATION CIR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-2959
Country	:	US
Telephone Number	:	646-260-3011
Fax Number	:

Provider Business Practice Location Address
First Line	:	714 PEACHTREE STATION CIR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-2959
Country	:	US
Telephone Number	:	646-260-3011
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. JOSCLYN J SPICER
Credential	:	BS, DMS
Telephone Number	:	646-260-3011

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	06/16/2015

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