Provider Demographics
NPI:1548567654
Name:DIAGNOSTICS IMAGING SERVICES
Entity Type:Organization
Organization Name:DIAGNOSTICS IMAGING SERVICES
Other - Org Name:OMI DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-802-1464
Mailing Address - Street 1:PO BOX 405052
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5052
Mailing Address - Country:US
Mailing Address - Phone:678-802-1464
Mailing Address - Fax:678-802-0271
Practice Address - Street 1:6584 PROFESSIONAL PL
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4942
Practice Address - Country:US
Practice Address - Phone:770-991-6001
Practice Address - Fax:770-991-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology