Provider Demographics
NPI:1164670667
Name:HOME CARE IMAGING
Entity Type:Organization
Organization Name:HOME CARE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARRIEM
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)(M) ARRT
Authorized Official - Phone:678-668-3101
Mailing Address - Street 1:187 SHERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5808
Mailing Address - Country:US
Mailing Address - Phone:678-668-3101
Mailing Address - Fax:404-696-1997
Practice Address - Street 1:187 SHERWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5808
Practice Address - Country:US
Practice Address - Phone:678-668-3101
Practice Address - Fax:404-696-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA326204335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier