Provider Demographics
NPI:1285663443
Name:CHATHAM RADIOLOGISTS, PA
Entity Type:Organization
Organization Name:CHATHAM RADIOLOGISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:912-355-2116
Mailing Address - Street 1:5354 REYNOLDS ST.
Mailing Address - Street 2:STE. 102
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6008
Mailing Address - Country:US
Mailing Address - Phone:912-355-2116
Mailing Address - Fax:912-355-3653
Practice Address - Street 1:5354 REYNOLDS ST.
Practice Address - Street 2:STE. 102
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6008
Practice Address - Country:US
Practice Address - Phone:912-355-2116
Practice Address - Fax:912-355-3653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACA1131OtherRR MEDICARE
GA300019740AMedicaid
GA=========AMedicare PIN