Provider Demographics
NPI:1790113082
Name:AMERICAN HEALTH IMAGING OF GEORGIA LLC
Entity Type:Organization
Organization Name:AMERICAN HEALTH IMAGING OF GEORGIA LLC
Other - Org Name:AMERICAN HEALTH IMAGING OF AUGUSTA LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:PO BOX 933367
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3367
Mailing Address - Country:US
Mailing Address - Phone:404-296-5887
Mailing Address - Fax:404-296-3129
Practice Address - Street 1:3152 PERIMETER PKWY UNIT B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-4583
Practice Address - Country:US
Practice Address - Phone:706-364-2603
Practice Address - Fax:706-364-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCB20060033745261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology