MEDICARE: DEPRIEST RADIOLOGY SERVICES PLC

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	174400000X	Specialist	MD30698	TN

General Provider Information

NPI Number	:	1487838058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPRIEST RADIOLOGY SERVICES PLC

Provider Business Mailing Address
First Line	:	PO BOX 6070
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30722-6070
Country	:	US
Telephone Number	:	866-457-9896
Fax Number	:	706-226-2283

Provider Business Practice Location Address
First Line	:	5001 E MAIN ST
Second Line	:
City	:	ERIN
State	:	TN
Zip	:	37061-4115
Country	:	US
Telephone Number	:	931-289-4211
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES V DEPRIEST
Credential	:	MD
Telephone Number	:	866-457-9896

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	03/27/2008

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