Provider Demographics
NPI:1952470999
Name:ATLANTIC RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ATLANTIC RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-525-3731
Mailing Address - Street 1:PO BOX 30367
Mailing Address - Street 2:DEPT 208
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0367
Mailing Address - Country:US
Mailing Address - Phone:910-525-3731
Mailing Address - Fax:
Practice Address - Street 1:105 WEST STREET
Practice Address - Street 2:
Practice Address - City:ROSEBORO
Practice Address - State:NC
Practice Address - Zip Code:28382
Practice Address - Country:US
Practice Address - Phone:910-525-3731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890134PMedicaid
2332129Medicare ID - Type Unspecified