MEDICARE: RADIOLOGY CONSULTATION SERVICES, PC

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	2085R0202X	Diagnostic Radiology Physician	34037	GA

General Provider Information

NPI Number	:	1508209602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY CONSULTATION SERVICES, PC

Provider Business Mailing Address
First Line	:	4545 HARRIS TRL NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3813
Country	:	US
Telephone Number	:	404-277-1502
Fax Number	:	404-420-2805

Provider Business Practice Location Address
First Line	:	4545 HARRIS TRL NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-3813
Country	:	US
Telephone Number	:	404-277-1502
Fax Number	:	404-420-2805

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID S OWENS
Credential	:	M.D.
Telephone Number	:	404-277-1502

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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