Provider Demographics
NPI:1578061636
Name:SUBSPECIALTY IMAGING, LLC
Entity Type:Organization
Organization Name:SUBSPECIALTY IMAGING, LLC
Other - Org Name:SUBSPECIALTY IMAGING CANTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-433-4123
Mailing Address - Street 1:PO BOX 48267
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30604-8267
Mailing Address - Country:US
Mailing Address - Phone:844-800-2326
Mailing Address - Fax:706-354-0529
Practice Address - Street 1:1495 HICKORY FLAT HWY STE 150
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-4229
Practice Address - Country:US
Practice Address - Phone:855-325-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBSPECIALTY IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty