Provider Demographics
NPI:1801834551
Name:MEDICA STAND-UP MRI, LLC
Entity Type:Organization
Organization Name:MEDICA STAND-UP MRI, LLC
Other - Org Name:MEDICA STAND-UP MRI OF ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-354-6766
Mailing Address - Street 1:6590 POWERS FERRY RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2933
Mailing Address - Country:US
Mailing Address - Phone:770-953-0108
Mailing Address - Fax:770-953-0109
Practice Address - Street 1:6590 POWERS FERRY RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2933
Practice Address - Country:US
Practice Address - Phone:770-953-0108
Practice Address - Fax:770-953-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA621512261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBJVMedicare ID - Type UnspecifiedMEDICARE IDTF NUMBER