Provider Demographics
NPI:1346371531
Name:INDEPENDENT DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:INDEPENDENT DIAGNOSTIC SERVICES
Other - Org Name:BODY MECHANICS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-297-1700
Mailing Address - Street 1:1296 SIMS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3850
Mailing Address - Country:US
Mailing Address - Phone:770-297-1700
Mailing Address - Fax:770-297-1702
Practice Address - Street 1:550 PEACHTREE STREET
Practice Address - Street 2:SUITE 1760
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-817-0734
Practice Address - Fax:404-817-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN199912247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty