Provider Demographics
NPI:1689706186
Name:SINORIEN HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:SINORIEN HEALTHCARE SERVICE
Other - Org Name:MONTREAL MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AVERIL
Authorized Official - Middle Name:DANTWAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-318-0476
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:112
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-492-0922
Mailing Address - Fax:770-492-0923
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:112
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-492-0922
Practice Address - Fax:770-492-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBJZMedicare ID - Type Unspecified