MEDICARE: WOMEN'S IMAGING SPECIALISTS - CANTON, 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	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1518428887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S IMAGING SPECIALISTS - CANTON, LLC

Provider Business Mailing Address
First Line	:	3180 N POINT PKWY STE 106
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4349
Country	:	US
Telephone Number	:	866-300-8512
Fax Number	:	800-613-8386

Provider Business Practice Location Address
First Line	:	203 OAKSIDE LN STE C
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-6407
Country	:	US
Telephone Number	:	706-445-6099
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER REDDY
Credential	:
Telephone Number	:	404-692-3493

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	05/15/2023

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