Provider Demographics
NPI:1598081093
Name:COLUMBUS DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:COLUMBUS DIAGNOSTIC CENTER INC
Other - Org Name:CDC NORTHSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-9122
Mailing Address - Street 1:PO BOX 931077
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1077
Mailing Address - Country:US
Mailing Address - Phone:706-256-3450
Mailing Address - Fax:706-256-3454
Practice Address - Street 1:7500 VETERANS PKWY STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2525
Practice Address - Country:US
Practice Address - Phone:706-323-7622
Practice Address - Fax:706-256-3454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS DIAGNOSTIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G707915Medicare UPIN