Provider Demographics
NPI:1093142101
Name:BABY DIMENSIONS
Entity Type:Organization
Organization Name:BABY DIMENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LANETTE
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS
Authorized Official - Phone:770-502-0225
Mailing Address - Street 1:20 BAKER RD STE 9
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2134
Mailing Address - Country:US
Mailing Address - Phone:770-502-0225
Mailing Address - Fax:
Practice Address - Street 1:20 BAKER RD STE 9
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2134
Practice Address - Country:US
Practice Address - Phone:770-502-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45982261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology