Provider Demographics
NPI:1386642015
Name:GBM ENTERPRISES, INC.
Entity Type:Organization
Organization Name:GBM ENTERPRISES, INC.
Other - Org Name:OPEN MRI OF DALTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-277-0106
Mailing Address - Street 1:PO BOX 6127
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-6127
Mailing Address - Country:US
Mailing Address - Phone:706-277-0106
Mailing Address - Fax:706-270-5858
Practice Address - Street 1:1507 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2500
Practice Address - Country:US
Practice Address - Phone:706-277-0700
Practice Address - Fax:706-277-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3509Medicare ID - Type Unspecified