Provider Demographics
NPI:1477094167
Name:OSSP IMAGING OF SOUTH ATLANTA
Entity Type:Organization
Organization Name:OSSP IMAGING OF SOUTH ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-290-2448
Mailing Address - Street 1:5788 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4904
Mailing Address - Country:US
Mailing Address - Phone:404-935-9116
Mailing Address - Fax:
Practice Address - Street 1:6630 EXCHANGE PL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2310
Practice Address - Country:US
Practice Address - Phone:404-935-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHO SPORT & SPINE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology