Provider Demographics
NPI:1811214760
Name:MDS DIGITAL X-RAY LLC
Entity Type:Organization
Organization Name:MDS DIGITAL X-RAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAREED
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-477-3792
Mailing Address - Street 1:2250 N DRUID HILLS RD NE
Mailing Address - Street 2:STE 270
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3192
Mailing Address - Country:US
Mailing Address - Phone:404-728-0000
Mailing Address - Fax:404-728-0801
Practice Address - Street 1:2250 N DRUID HILLS RD NE
Practice Address - Street 2:STE 270
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3192
Practice Address - Country:US
Practice Address - Phone:404-728-0000
Practice Address - Fax:404-728-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier