Provider Demographics
NPI:1598152902
Name:MARIETTA IMAGING, LLC
Entity Type:Organization
Organization Name:MARIETTA IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-296-5887
Mailing Address - Street 1:2200 CENTURY PKWY NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3154
Mailing Address - Country:US
Mailing Address - Phone:404-296-5887
Mailing Address - Fax:404-296-3129
Practice Address - Street 1:796 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7228
Practice Address - Country:US
Practice Address - Phone:404-296-5887
Practice Address - Fax:404-296-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology