Provider Demographics
NPI:1346606506
Name:AMERICAN HEALTH IMAGING OF GEORGIA, LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH IMAGING OF GEORGIA, LLC
Other - Org Name:AMERICAN HEALTH IMAGING OF CUMMING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-362-5391
Mailing Address - Street 1:PO BOX 933367
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3367
Mailing Address - Country:US
Mailing Address - Phone:404-296-5887
Mailing Address - Fax:404-296-3129
Practice Address - Street 1:1050 HAW CREEK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:678-845-2150
Practice Address - Fax:678-845-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G477813Medicare PIN