Provider Demographics
NPI:1346255080
Name:OPEN MRI OF MILLEDGEVILLE LLC
Entity Type:Organization
Organization Name:OPEN MRI OF MILLEDGEVILLE 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:706-256-3450
Mailing Address - Street 1:PO BOX 933274
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3274
Mailing Address - Country:US
Mailing Address - Phone:866-560-7610
Mailing Address - Fax:706-256-3454
Practice Address - Street 1:1850 NORTH COLUMBIA STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7113
Practice Address - Country:US
Practice Address - Phone:478-453-4101
Practice Address - Fax:706-256-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00307290OtherRAILROAD MEDICARE
47BBBNMMedicare ID - Type Unspecified
GA511G700001Medicare PIN