Provider Demographics
NPI: | 1598038606 |
---|---|
Name: | ATLANTIC RADIOLOGY ASSOCIATES |
Entity Type: | Organization |
Organization Name: | ATLANTIC RADIOLOGY ASSOCIATES |
Other - Org Name: | MEMORIAL HEALTH RADIOLOGY DEPARTMENT |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFF |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KINLAW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 912-350-8466 |
Mailing Address - Street 1: | PO BOX 14185 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAVANNAH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31416-1185 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 912-350-8466 |
Mailing Address - Fax: | 786-975-2608 |
Practice Address - Street 1: | 4700 WATERS AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAVANNAH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31404-6220 |
Practice Address - Country: | US |
Practice Address - Phone: | 912-350-8466 |
Practice Address - Fax: | 912-350-3532 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-02-21 |
Last Update Date: | 2023-09-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |