Provider Demographics
NPI:1407237449
Name:SHYNE LITE IMAGING SOLUTIONS LLC
Entity Type:Organization
Organization Name:SHYNE LITE IMAGING SOLUTIONS LLC
Other - Org Name:SHYNE LITE DIAGNOSTIC IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSCLYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DMS
Authorized Official - Phone:646-260-3011
Mailing Address - Street 1:714 PEACHTREE STATION CIR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2959
Mailing Address - Country:US
Mailing Address - Phone:646-260-3011
Mailing Address - Fax:
Practice Address - Street 1:714 PEACHTREE STATION CIR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2959
Practice Address - Country:US
Practice Address - Phone:646-260-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15033127261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology