MEDICARE: OSSP IMAGING GLENDRIDGE

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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1871259150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSSP IMAGING GLENDRIDGE

Provider Business Mailing Address
First Line	:	5788 ROSWELL RD STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-4904
Country	:	US
Telephone Number	:	678-752-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	5416 GLENRIDGE DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1342
Country	:	US
Telephone Number	:	678-752-7246
Fax Number	:

Authorized Official
Title or Position	:	RCM DIRECTOR
Name	:	FAITH A BELTZHOOVER
Credential	:
Telephone Number	:	678-752-7246

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/12/2021

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Directions to “OSSP IMAGING GLENDRIDGE ” Practice Location

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