Provider Demographics
NPI:1477240075
Name:BREAST IMAGING OF GEORGIA PA
Entity Type:Organization
Organization Name:BREAST IMAGING OF GEORGIA PA
Other - Org Name:BREAST IMAGING OF GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CUTRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-642-5710
Mailing Address - Street 1:PO BOX 7801
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7801
Mailing Address - Country:US
Mailing Address - Phone:714-642-5710
Mailing Address - Fax:
Practice Address - Street 1:2300 MANCHESTER EXPY STE A001
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6805
Practice Address - Country:US
Practice Address - Phone:706-257-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty