Provider Demographics
NPI:1548785330
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 BRUNSWICK, 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:PO BOX 933367
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3367
Mailing Address - Country:US
Mailing Address - Phone:404-297-5207
Mailing Address - Fax:404-478-8944
Practice Address - Street 1:1103 FOUNTAIN LAKE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-3039
Practice Address - Country:US
Practice Address - Phone:404-297-5207
Practice Address - Fax:404-478-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty