Provider Demographics
NPI:1093017006
Name:IMAGING CENTERS OF GEORGIA, INC.
Entity Type:Organization
Organization Name:IMAGING CENTERS OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-302-5270
Mailing Address - Street 1:108 OLYMPIA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3682
Mailing Address - Country:US
Mailing Address - Phone:478-302-5270
Mailing Address - Fax:478-302-5280
Practice Address - Street 1:108 OLYMPIA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093
Practice Address - Country:US
Practice Address - Phone:478-302-5270
Practice Address - Fax:478-302-5280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLTON HEALTHCARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-23
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QH0100X, 261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology