Provider Demographics
NPI:1598102535
Name:TELEMAMMOGRAPHY SPECIALISTS LLC
Entity Type:Organization
Organization Name:TELEMAMMOGRAPHY SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-687-8649
Mailing Address - Street 1:125 E TRINITY PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3360
Mailing Address - Country:US
Mailing Address - Phone:404-687-8649
Mailing Address - Fax:404-687-8945
Practice Address - Street 1:125 E TRINITY PL
Practice Address - Street 2:SUITE 201
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3360
Practice Address - Country:US
Practice Address - Phone:404-687-8649
Practice Address - Fax:404-687-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty