Provider Demographics
NPI:1598112336
Name:CENTER FOR MEDICAL DIAGNOSTICS OF GEORGIA
Entity Type:Organization
Organization Name:CENTER FOR MEDICAL DIAGNOSTICS OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-683-0970
Mailing Address - Street 1:11560 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-5873
Mailing Address - Country:US
Mailing Address - Phone:256-382-1603
Mailing Address - Fax:256-382-1607
Practice Address - Street 1:2227 DRAKE AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-5199
Practice Address - Country:US
Practice Address - Phone:256-382-1603
Practice Address - Fax:256-382-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69541225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty