Provider Demographics
NPI:1689606188
Name:UNIVERSAL RADIOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:UNIVERSAL RADIOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-922-4281
Mailing Address - Street 1:2929 WATSON BLVD STE 2
Mailing Address - Street 2:PMB 125
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-9601
Mailing Address - Country:US
Mailing Address - Phone:478-333-3603
Mailing Address - Fax:478-333-3685
Practice Address - Street 1:1601 WATSON BLVD
Practice Address - Street 2:HOUSTON MEDICAL CENTER, ATTN: RADIOLOGY DEPT
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3431
Practice Address - Country:US
Practice Address - Phone:478-333-3603
Practice Address - Fax:478-333-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA563632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
611651800OtherUS DEPT OF LABOR GROUP #
GAGRP7781Medicare ID - Type UnspecifiedGROUP PROVIDER #
GAGRP7781Medicare PIN