Provider Demographics
NPI:1508425380
Name:AMERICAN HEALTH IMAGING OF GEORGIA LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH IMAGING OF GEORGIA LLC
Other - Org Name:AMERICAN HEALTH IMAGING OF MARIETTA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-362-5391
Mailing Address - Street 1:2200 CENTURY PKWY NE STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3116
Mailing Address - Country:US
Mailing Address - Phone:404-297-5207
Mailing Address - Fax:404-478-8944
Practice Address - Street 1:796 CHURCH ST NE STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7228
Practice Address - Country:US
Practice Address - Phone:678-376-8908
Practice Address - Fax:678-376-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology