Provider Demographics
NPI:1346542123
Name:NU-IMAGING MEDICAL DIAGNOSTIC & THERAPY
Entity Type:Organization
Organization Name:NU-IMAGING MEDICAL DIAGNOSTIC & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHASHIKANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-471-6073
Mailing Address - Street 1:839 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3760
Mailing Address - Country:US
Mailing Address - Phone:678-471-6073
Mailing Address - Fax:770-964-1105
Practice Address - Street 1:839 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3760
Practice Address - Country:US
Practice Address - Phone:678-471-6073
Practice Address - Fax:770-964-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG84829Medicare UPIN
GA08BBRTJMedicare UPIN