Provider Demographics
NPI:1598294688
Name:MONTCLAIR ROAD IMAGING, LLC
Entity Type:Organization
Organization Name:MONTCLAIR ROAD IMAGING, LLC
Other - Org Name:IMAGESOUTH PET/CT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-256-3450
Mailing Address - Street 1:PO BOX 931108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1108
Mailing Address - Country:US
Mailing Address - Phone:205-870-1979
Mailing Address - Fax:205-870-1929
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 140
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2629
Practice Address - Country:US
Practice Address - Phone:205-870-1979
Practice Address - Fax:205-870-1929
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTCLAIR ROAD IMAGING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-12
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology