Provider Demographics
NPI:1104039486
Name:USMAMMO
Entity Type:Organization
Organization Name:USMAMMO
Other - Org Name:USTELEMAMMOGRAPHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-419-6644
Mailing Address - Street 1:1175 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1425
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30361-6202
Mailing Address - Country:US
Mailing Address - Phone:404-419-6644
Mailing Address - Fax:678-904-2591
Practice Address - Street 1:1175 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1425
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-6202
Practice Address - Country:US
Practice Address - Phone:404-419-6644
Practice Address - Fax:678-904-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0609796261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography