Provider Demographics
NPI:1609019629
Name:NEW AGE DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:NEW AGE DIAGNOSTIC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-314-1648
Mailing Address - Street 1:3100 GENTIAN BLVD
Mailing Address - Street 2:SUITE 22B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5636
Mailing Address - Country:US
Mailing Address - Phone:720-314-1648
Mailing Address - Fax:866-851-3360
Practice Address - Street 1:3100 GENTIAN BLVD
Practice Address - Street 2:SUITE 22B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5636
Practice Address - Country:US
Practice Address - Phone:720-314-1648
Practice Address - Fax:866-851-3360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory