Provider Demographics
NPI:1114149192
Name:INTERVENTIONAL RADIOLOGY ASSOC OF ATLANTA PC
Entity Type:Organization
Organization Name:INTERVENTIONAL RADIOLOGY ASSOC OF ATLANTA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-2767
Mailing Address - Street 1:4205 N POINT PKWY
Mailing Address - Street 2:BUILDING D
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8808
Mailing Address - Country:US
Mailing Address - Phone:770-619-2767
Mailing Address - Fax:770-619-2760
Practice Address - Street 1:4205 N POINT PKWY
Practice Address - Street 2:BUILDING D
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8808
Practice Address - Country:US
Practice Address - Phone:770-619-2767
Practice Address - Fax:770-619-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1623608OtherCIGNA
GAGRP8069Medicare PIN