Provider Demographics
NPI:1831102268
Name:HIGHLAND RADIOLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HIGHLAND RADIOLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT GROUP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-457-9896
Mailing Address - Street 1:PO BOX 6070
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:866-457-9896
Mailing Address - Fax:706-266-2283
Practice Address - Street 1:111 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055
Practice Address - Country:US
Practice Address - Phone:866-457-9896
Practice Address - Fax:706-226-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3721245Medicaid
TNCH7179OtherRAILROAD MEDICARE
=========OtherTRICARE
TN3721245Medicaid