Provider Demographics
NPI:1457300832
Name:DIAGNOSTIC HEALTH CORPORATION
Entity Type:Organization
Organization Name:DIAGNOSTIC HEALTH CORPORATION
Other - Org Name:TARA DIAGNOSTIC CENTER A HEALTHSOUTH FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-685-5001
Mailing Address - Street 1:225 MEDICAL WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2522
Mailing Address - Country:US
Mailing Address - Phone:770-991-6747
Mailing Address - Fax:770-907-7801
Practice Address - Street 1:225 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2522
Practice Address - Country:US
Practice Address - Phone:770-991-6747
Practice Address - Fax:770-907-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBMSMedicare ID - Type UnspecifiedIDTF