Provider Demographics
NPI:1487838058
Name:DEPRIEST RADIOLOGY SERVICES PLC
Entity Type:Organization
Organization Name:DEPRIEST RADIOLOGY SERVICES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-457-9896
Mailing Address - Street 1:PO BOX 6070
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-6070
Mailing Address - Country:US
Mailing Address - Phone:866-457-9896
Mailing Address - Fax:706-226-2283
Practice Address - Street 1:5001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-4115
Practice Address - Country:US
Practice Address - Phone:931-289-4211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38284502Medicare PIN