Provider Demographics
NPI:1851324529
Name:GEORGIA HEALTH IMAGING
Entity Type:Organization
Organization Name:GEORGIA HEALTH IMAGING
Other - Org Name:PROGRESSIVE HEALTH LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BUDHWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS(MD), RDMS
Authorized Official - Phone:678-924-0964
Mailing Address - Street 1:3653 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4107
Mailing Address - Country:US
Mailing Address - Phone:678-924-0964
Mailing Address - Fax:678-924-0965
Practice Address - Street 1:3653 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-4107
Practice Address - Country:US
Practice Address - Phone:678-924-0964
Practice Address - Fax:678-924-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
GA010492261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA901280491AMedicaid
GA=========OtherTAX ID
GA47 BBBLGMedicare ID - Type UnspecifiedMEDICARE ID