Provider Demographics
NPI:1114928207
Name:CASCADE RADIOLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:CASCADE RADIOLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-980-8970
Mailing Address - Street 1:1810 MULKEY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1151
Mailing Address - Country:US
Mailing Address - Phone:770-980-8970
Mailing Address - Fax:770-980-8975
Practice Address - Street 1:1810 MULKEY RD
Practice Address - Street 2:STE 103
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1151
Practice Address - Country:US
Practice Address - Phone:770-980-8970
Practice Address - Fax:770-980-8975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4324Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER