Provider Demographics
NPI:1225044068
Name:JOHN CREEK DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:JOHN CREEK DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:705-256-3450
Mailing Address - Street 1:PO BOX 933556
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3556
Mailing Address - Country:US
Mailing Address - Phone:706-256-3450
Mailing Address - Fax:706-256-3454
Practice Address - Street 1:6920 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6672
Practice Address - Country:US
Practice Address - Phone:678-835-2299
Practice Address - Fax:706-256-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700002Medicare PIN