Provider Demographics
NPI:1245572403
Name:NOMADX, INC.
Entity Type:Organization
Organization Name:NOMADX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCCHESI
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:561-602-4300
Mailing Address - Street 1:18 VANDERBILT POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2307
Mailing Address - Country:US
Mailing Address - Phone:404-826-9279
Mailing Address - Fax:
Practice Address - Street 1:18 VANDERBILT POINTE WAY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2307
Practice Address - Country:US
Practice Address - Phone:404-826-9279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile