Provider Demographics
NPI:1518916709
Name:RADIOLOGY GROUP PA
Entity Type:Organization
Organization Name:RADIOLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-355-7133
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-2007
Mailing Address - Country:US
Mailing Address - Phone:256-355-7133
Mailing Address - Fax:256-350-6361
Practice Address - Street 1:1201 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3337
Practice Address - Country:US
Practice Address - Phone:256-355-7133
Practice Address - Fax:256-350-6361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H491Medicare PIN