Provider Demographics
NPI:1568536050
Name:SMALL WONDERS IMAGING, LLC
Entity Type:Organization
Organization Name:SMALL WONDERS IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:RACQUEL
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS, RVT
Authorized Official - Phone:843-817-6345
Mailing Address - Street 1:308 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6048
Mailing Address - Country:US
Mailing Address - Phone:843-817-6345
Mailing Address - Fax:
Practice Address - Street 1:308 S PINE ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6048
Practice Address - Country:US
Practice Address - Phone:843-817-6345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC792752471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty