MEDICARE: MDS DIGITAL X-RAY 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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1811214760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDS DIGITAL X-RAY LLC

Provider Business Mailing Address
First Line	:	2250 N DRUID HILLS RD NE
Second Line	:	STE 270
City	:	ATLANTA
State	:	GA
Zip	:	30329-3192
Country	:	US
Telephone Number	:	404-728-0000
Fax Number	:	404-728-0801

Provider Business Practice Location Address
First Line	:	2250 N DRUID HILLS RD NE
Second Line	:	STE 270
City	:	ATLANTA
State	:	GA
Zip	:	30329-3192
Country	:	US
Telephone Number	:	404-728-0000
Fax Number	:	404-728-0801

Authorized Official
Title or Position	:	V. PRESIDENT
Name	:	MR. FAREED A SIDDIQUI
Credential	:
Telephone Number	:	678-477-3792

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	04/30/2010

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