Provider Demographics
NPI:1053858761
Name:MOBILE MEDICAL IMAGING OF COASTAL GEORGIA, LLC
Entity Type:Organization
Organization Name:MOBILE MEDICAL IMAGING OF COASTAL GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R) ARRT
Authorized Official - Phone:912-295-5611
Mailing Address - Street 1:5906 HWY 21 S
Mailing Address - Street 2:UNIT 4
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-5505
Mailing Address - Country:US
Mailing Address - Phone:912-295-5611
Mailing Address - Fax:844-895-6771
Practice Address - Street 1:5906 HWY 21 S
Practice Address - Street 2:UNIT 4
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31326-5505
Practice Address - Country:US
Practice Address - Phone:912-295-5611
Practice Address - Fax:844-895-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier