Provider Demographics
NPI:1962510958
Name:THE IMAGING CENTER
Entity Type:Organization
Organization Name:THE IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HUEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-737-4575
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4480
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:818 ST. SEBASTIAN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-3574
Practice Address - Fax:706-731-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085P0229X, 2085U0001X, 261QR0200X, 261QR0206X
GA0147252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1418019OtherUNITED MINE WORKERS
1023072147OtherNPI - JIMPSEY B. JOHNSON
16-00225OtherUNITED HEALTHCARE
GA00015804CMedicaid
1033173067OtherNPI - HUEY G. BULLOCK
156858201OtherFEDERAL BLACK LUNG
SCSL0006Medicaid
GA47BBBDLMedicare PIN