Provider Demographics
NPI:1033136080
Name:ATLANTIC RADIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ATLANTIC RADIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-350-0552
Mailing Address - Street 1:PO BOX 14185
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1185
Mailing Address - Country:US
Mailing Address - Phone:912-350-8466
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-8436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0282982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA233066832AMedicaid
611082300OtherDOL
SCGPA906Medicaid
SCGPA906Medicaid