MEDICARE: TOTAL THERMAL 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	247200000X	Other Technician

General Provider Information

NPI Number	:	1558783928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL THERMAL IMAGING, LLC

Provider Business Mailing Address
First Line	:	368 W PIKE ST
Second Line	:	SUITE 107
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-3240
Country	:	US
Telephone Number	:	770-545-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	368 W PIKE ST
Second Line	:	SUITE 107
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-3240
Country	:	US
Telephone Number	:	770-545-8590
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REBECCA PADEN
Credential	:
Telephone Number	:	770-545-8590

Provider Enumeration Date	:	01/20/2014
Last Update Date	:	01/20/2014

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