Provider Demographics
NPI:1154083194
Name:ADVANCED MOBILE CARDIOVASCULAR IMAGING, LLC
Entity Type:Organization
Organization Name:ADVANCED MOBILE CARDIOVASCULAR IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIAC IMAGING SPECIALIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENYA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:706-251-5370
Mailing Address - Street 1:3439 GEBHARDT CT
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4148
Mailing Address - Country:US
Mailing Address - Phone:706-251-5370
Mailing Address - Fax:
Practice Address - Street 1:3439 GEBHARDT CT
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4148
Practice Address - Country:US
Practice Address - Phone:706-251-5370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile