Provider Demographics
NPI:1346608239
Name:ELITE RADIOLOGY OF GEORGIA, LLC
Entity Type:Organization
Organization Name:ELITE RADIOLOGY OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-463-4442
Mailing Address - Street 1:607 W MLK BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3453
Mailing Address - Country:US
Mailing Address - Phone:813-238-3833
Mailing Address - Fax:813-849-6349
Practice Address - Street 1:4800 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-4897
Practice Address - Country:US
Practice Address - Phone:404-419-2058
Practice Address - Fax:404-381-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA695742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty