Provider Demographics
NPI:1083628523
Name:DIAGNOSTIC IMAGING SERVICES
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING SERVICES
Other - Org Name:OMI DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SYVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-802-1464
Mailing Address - Street 1:P.O. BOX 421548
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:770-489-4600
Mailing Address - Fax:770-489-4645
Practice Address - Street 1:4586 TIMBER RIDGE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-489-4600
Practice Address - Fax:770-489-4645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIAGNOSTIC IMAGING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0603636261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBHMMedicare ID - Type UnspecifiedMEDICARE ID NUMBER