Provider Demographics
NPI:1477586568
Name:DUNWOODY IMAGING, LLC
Entity Type:Organization
Organization Name:DUNWOODY IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-451-4040
Mailing Address - Street 1:1750 OLD SPRING HOUSE LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6214
Mailing Address - Country:US
Mailing Address - Phone:770-451-4040
Mailing Address - Fax:770-451-3003
Practice Address - Street 1:1750 OLD SPRING HOUSE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6214
Practice Address - Country:US
Practice Address - Phone:770-451-4040
Practice Address - Fax:770-451-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0314322471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000449765ABMedicaid
GAE19660Medicare UPIN
GA000449765ABMedicaid
GAGRP7671Medicare PIN