Provider Demographics
NPI:1225376866
Name:RIVERSIDE IMAGING SPECIALISTS, LLC
Entity Type:Organization
Organization Name:RIVERSIDE IMAGING SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:478-745-6747
Mailing Address - Street 1:2140 RIVERSIDE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1747
Mailing Address - Country:US
Mailing Address - Phone:478-745-6747
Mailing Address - Fax:478-745-6749
Practice Address - Street 1:2140 RIVERSIDE DR
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1747
Practice Address - Country:US
Practice Address - Phone:478-745-6747
Practice Address - Fax:478-745-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology