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NPI Code Detail

MEDICARE: RADIOLOGY ASSOCIATES OF HOUSTON COUNTY

MEDICARE: RADIOLOGY ASSOCIATES OF HOUSTON COUNTY
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
12085R0202XDiagnostic Radiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578571956
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIOLOGY ASSOCIATES OF HOUSTON COUNTY
Provider Business Mailing Address
First Line : 1605 LAKES PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30043-5858
Country : US
Telephone Number : 770-237-1148
Fax Number : 770-237-6148
Provider Business Practice Location Address
First Line : 601 BLUEBIRD BLVD
Second Line :
City : FORT VALLEY
State : GA
Zip : 31030-5082
Country : US
Telephone Number : 478-825-0310
Fax Number :
Authorized Official
Title or Position : PRACTICE MANAGER
Name : GREG L DOVER
Credential : CPA
Telephone Number : 770-237-1558
Provider Enumeration Date : 08/03/2006
Last Update Date : 05/13/2008

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Directions to “RADIOLOGY ASSOCIATES OF HOUSTON COUNTY ” Practice Location

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